Mark Holmes's Activities

Should dental radiography be mandatory?

David Mills — Sun, 01 Mar 2026 20:15:19 GMT

I had a lovely debate on an ethics panel at the BVDA Congress yesterday (thanks Rob Davis) where the last discussion point was that dental radiography should be mandatory for practices carrying out dental procedures. I believe there are some moves to make this a RCVS requirement.

What do people think?

This article summarises it better than the above

pmc.ncbi.nlm.nih.gov/.../

My take is that you need an incontrovertible reason (i.e. to as to be sure) to make anything mandatory. Equally, I can see the benefits of dental rads. But are the benefits so overwhelming and the risks so severe to justify the position?

Do you think it's OK to 'have a go' at surgery any more?

Arlo Guthrie — Tue, 14 Apr 2026 08:40:53 GMT

We live in an era of refer-all, and from time to time I hear vets saying they are frightened to give something a go (either because of repercussions from client or from RCVS if it goes wrong), or just that it's not the done thing any more.

Would you agree that far fewer vets are happy to give something a go these days?

Do you think that is a good or a bad thing?

If you think it is a bad thing, then what do you think are the main drivers of the refer-all culture or barriers to 'having a go'.

Pesticides in songbird's nests

Cinzia Gandini — Wed, 19 Feb 2025 13:31:10 GMT

Has anyone had the chance to read an article published on a newspaper and from there read the article published on a scientific journal with impact factor 8.2? What's your thinking about it?

https://www.theguardian.com/environment/2025/jan/27/pet-fur-found-in-songbird-nests-contains-high-levels-of-pesticides-study-finds

https://www.sciencedirect.com/science/article/pii/S0048969725000737?ref=pdf_download&fr=RR-2&rr=908a988c1c6d63c1

will you continue treating dogs/cats all year around for fleas and ticks even if you never find any evidence of it being a beneficial treatment compared to actually treat the animal if it's needed? Were you anyway doing as suggested?

how do you manage cytology for ear swabs

ian bates — Fri, 14 Feb 2025 09:49:53 GMT

Hello all,

There is increasing pressure to perform ear swabs and in house cytology before prescribing medications (esp antibiotics obviously). But for those already doing this, how do you manage the consultation - and charges?

Do you have someone in the back doing the staining and cytology whilst the consult is in progress ? or do you do it yourself during a consulting period and make the client wait? - how long do you allow for a consult in that case?

Or -do you do the cytology after consulting has finished and get the client to come back if antibiotics are required? (and if so, how annoyed are the clients at having to make a double trip?!?! - some of ours live 30 mins away)

An ear consult can already cost over £100 - what do you charge for the cytology please?

Are there any topical preps with steroid and miconazole only, that I am unaware of.......?

Thanks in advance!

Ian

Quality Improvements to Tackling Brachycephalic Dogs

Bob Partridge — Mon, 10 Feb 2025 23:08:28 GMT

Dear All,

The Veterinary Specialist Association is holding a meeting to discuss quality improvement approaches to tackling Brachies.

Please click the link below.

Applying a Quality Improvement Approach to Brachycephalic Dogs - VSA

So not just anaesthetic considerations – but GI and emotional stuff too. There will also be discussion-breakout groups & conclusions.

It will be a fascinating meeting & not just your average “This is how you cut the nasal planum”

The meeting is open to all – indeed any “Resident” can apply for free membership of VSA & get the discounted member rate!

Spaces seem to be going quite quickly, so if you know of anyone with an interest in Frenchies etc……

All best

Bob

Night time separation anxiety (canine)

Sara Ramsey — Wed, 05 Feb 2025 21:28:32 GMT

This is a 6 year old working cocker spaniel. My colleague saw the dog and referred him to a clinical canine behaviourist.

They have had an assessment and a behavioural modification plan is in place and the behaviourist communicated with us about some anti anxiety medication to help the dog focus on his plan at night time

He was dispensed gabapentin, 14mg/kg BID and trazodone 6mg/kg SID. It seemed to settle him for the first two nights but now he is back to pacing and whining constantly until he falls asleep sitting up. He will settle if allowed in the owners bed. He used to sleep in his crate very well.

I have asked if co sleeping would be a long term solution (obvious solution!) It's not, and there is a valid reason.

I have spoken to the behaviourist and we are going to try an analgesia trial.

I wondered if anyone might have some advice. I'm not hugely experienced in pharmaceuticals for behavioural issues, I have used fluoexetine (highly reactive Frenchie) and alprazolam for fireworks ...but not sure if indicated here?

Many thanks, it's a really tough situation with very dedicated and sensible owners.

Trocoxil being discontinued - best alternative?

Beats — Mon, 13 Jan 2025 13:27:01 GMT

3 year GSD that has awful hips and has lived on trocoxil 95mg monthly for most of the last 2 years.

Any of the daily NSAIDs tried to-date have made vomit shortly after taking tablet or caussed diarrhoea.

Librella been tried and not a success. Galliprant not tried, but would doubt would be the answer.

I'm going to try Enflicoxib (Daxocox), but never used if before, so interested in any feedback on whether that can be a good solution for dogs where trcoxil worked well as they simply didn't tolerate the daily assault of their GI system with an NSAID.

Other NSAIDs for dogs I found on VMD website are:

Meloxicom

Firicoxib

Carprofen

Cimicoxib

Ketoprofen

Robenacoxib

Tolfenamic acid

I'm I missing anything else to consider replacing the trocoxil with (other than a hip replacement).

Must say I liked trocoxil for these cases, so really sad that it is going.

Do you guys think this paw will be viable?

Tomas B — Tue, 21 Jan 2025 20:29:02 GMT

Hello guys

This cat was seen by me for 4 metacarpal fratures were plates and screws were appllied. A bandage was placed afterwards, toes out, to prevent swelling and the owners advised to go to referring Vets to remove it in 3-5 days.

Today I asked the owners for pictures (3 days after bandage applied) and the owners sent this. I was shocked about the poor management of the cat. Its swollen, dirty and they reported multiple times the paw was ok and cat was doing fine.

I immediately advised to go to the out of hours Vets to remove the bandage and search immediate care.

Do you guys think this paw will be viable?

Thank you

Can you suggest protocols for chemical sterilisation of a bitch?

Stigen — Mon, 06 Jan 2025 14:39:36 GMT

I have a patient now: 4 year old springer spaniel unneutered bitch. LAst 2 oestrus the dog was peing inndoors same place daily, and drinking more. Otherwise ok, and urinating normally on walks. It was examined 6 months ago when it had the last oestrus, and full urinanalysis, full biochemical profile,hematology and CRP was checked - all fine. Ultrasound bladder fine. So was deemed as hormonally induced behaviour as it only happens during oestrus.

Owner wants dog sterilised now. I am a bit hesitant to do it, as I fear it potentially can cause spinchter incontinence which would be much worse to deal with. But Owner has very expensive floors apparently and don`t want no pee there.

I am thinking about trying a chemical solution to see how the response is, and consider surgical solution if that has the wanted response(but still with no guarantee when it comes to incontinence.) The dog is entering a new oestrus in 4 weeks. Any suggested protocols ? I used Depo Provera in the past, but not sure if that is OK, it potentially increases incidence of pyometra. Also Suprelorin off label is an option, but as I understand that can actually induce oestrus when given this late in anoestrus.

Any suggestions?

How do you feel about the delegation of diagnostic imaging to RVNs?

Arlo Guthrie — Fri, 10 Jan 2025 11:35:52 GMT

https://www.vetsurgeon.org/b/veterinary-news/posts/cvs-delegates-diagnostic-imaging-to-veterinary-nurses

[Film] What is pragmatic vet med anyway?

Arlo Guthrie — Wed, 08 Jan 2025 18:11:08 GMT

"Contextual" and "pragmatic" care are the two buzzwords that have been doing the rounds over the last few months.

In the context of the CMA investigation, they're a nod to the growing view that veterinary care needs to be more affordable, without using words like 'affordable'.

But words mean different things to different people, so I went and visited Blue Cross in London, to see how they define pragmatic care. After all, if anyone knows about pragmatism, it's them!

What do you think? Do you like the Blue Cross definition? Do you think the profession as a whole needs to be more pragmatic - not just vets but the regulator too.

www.youtube.com/.../ZtpVbyRSBDE

[Film] Why have vet bills gone up so much?

Arlo Guthrie — Wed, 16 Oct 2024 21:14:56 GMT

Here is the first of a series of films I am making which look at the reasons for the increasing cost of veterinary care. If you think they might help foster greater understanding amongst owners, you might like to share them. Films will also be available on all the major social networks and of course YouTube

youtube.com/.../lg_EeamSbSI

New RCVS guidance on referring cases

Arlo Guthrie — Mon, 19 Aug 2024 09:30:00 GMT

The RCVS has tightened up the Code of Professional Conduct concerning how general practitioners refer cases and how veterinary professionals talk about referral surgeons.

The first change has been made to paragraph 1.6 which now advises general practitioners to check whether the vet they are referring a case to is on the RCVS Specialist or Advanced Practitioner list, explaining the difference to the client and what sets them apart from other vets who might be prepared to accept a referral.

Also, practitioners who accept a referral should provide information to the referrer about the experience and status of those likely to be responsible for the case.

The guidance about conflicts of interest in paragraph 1.7 has also been amended such that referring surgeons should tell clients if they are referring their case to a practice owned by the same group.

There is new guidance about how vets and nurses talk about referral practitioners, with the new advice being to focus on accepted terms such as 'RCVS Specialist' and 'RCVS Advanced Practitioner', and avoid more general terms like 'referral surgeon' or 'consultant' to avoid confusion or implying that individuals hold more qualifications than they do.

Lastly, there is new guidance that vets may only use the name 'Specialist' in the name of their practice where there is genuine and meaningful involvement, and oversight, in case management by at least one RCVS specialist in all disciplines where any clinical services are offered under the business name.

https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/referrals-and-second-opinions/

BVA joint response to the CMA misses the point

Arlo Guthrie — Fri, 12 Apr 2024 15:29:00 GMT

The BVA has submitted a joint response with the BSAVA, SPVS, BVNA and VMG to the Competition and Markets Authority consultation on a proposed market investigation.

The response offers further evidence concerning the CMA’s potential concerns, and says that voluntary measures relating to transparency of fees and ownership could be introduced before the conclusion of a market investigation.

The BVA has formed a working group to develop guidance on transparency, client choice and the value of veterinary care to support companion animal practices.

British Veterinary Association President Anna Judson, said: “We’re keen to see healthy competition and consumer choice and we recognise that some of the areas identified by the CMA would benefit from further scrutiny.

"We are already taking steps to support vet practices by developing guidance for the profession in relation to transparency of fees, transparency of ownership, prescribing and dispensing of veterinary medicines, and contextualised care.

“However, we are extremely disappointed to see the suggestion in the CMA’s report, as well as in subsequent media reporting, that veterinary professionals might prey on owners’ desire to do the best for their pets by using these circumstances as a “strategy” to promote more sophisticated or expensive treatment.

"Vets enter this high-pressure profession out of genuine care for animals and will always prioritise their health and welfare."

“We also have significant concerns about the suggestion that practices might be mandated to provide information to clients about quality or outcome-related measures.

"We do not see primary concerns about the quality of veterinary treatment and we believe such a requirement would not meaningfully support consumer choice.

"Instead, it would be extremely challenging to deliver and could significantly exacerbate many of the complex issues faced by our members, who are already under significant pressure.

There will be a panel discussion about the CMA investigation at BVA Live this year.

https://bvalive.vetshow.com

COMMENT

There are lots of good points made in this latest response to the CMA, if no more than a nod to the real issue here: which is the often eye-watering cost of modern veterinary care.

But it is hugely disappointing to see the BVA (and others) berating the CMA and the media for suggesting that vets might prey on owners' desire to do the best for their pet, rather than asking WHY people think that, and how can the profession regain trust.

That, surely, is the starting point here: for the profession to stop feeling sorry for itself, and instead think how it can change to meet the needs of its customers and dispel their perception of being taken for a ride.

The CMA investigation is a bit of a red herring: the price of veterinary care is not going to be significantly changed by displaying the prices for a few standard procedures on practice websites, with greater transparency over practice ownership or with slightly cheaper prescriptions, all of which is just tinkering.

The biggest influence on the size of the client's bill is not marketplace competition, it's the vet's recommendation.

Paul Manktelow, Chief Vet at the Blue Cross has already hit the nail square on the head when he called on the profession to practise pragmatic medicine.

The BVA now alludes to this with talk in its response of 'contextualised care' - a concept which allows practitioners to offer pragmatic medicine (aka what people can afford, rather than 'gold standard'), without the judgement that it is inherently associated with.

The benefits of 'contextualised care' are well explained by Ruth Serlin at VDS Training here.

That's great, but will it be enough?

Perhaps not, because whilst someone might be happy to walk out of the car showroom with a Dacia Sandero knowing they cannot afford a Bentley, they may be less happy to accept the Dacia level of care for their beloved pet, when they watched 'Supervet' only the night before.

If that's true, then pragmatic medicine will have to be combined with all sorts of other measures, such as reviewing and reducing the cost of regulation, questioning the value of diagnostics and changing to a less 'referall' (sic) culture.

RCVS Council votes to abolish elections

Arlo Guthrie — Thu, 18 Jan 2024 17:47:00 GMT

At its January meeting today, RCVS Council agreed a series of proposals for the future reform of the College's governance structure which will now go to consultation with the profession and the public before being integrated into the overall recommendations for legislative reform.

Amongst the proposals agreed by Council was to move towards an independent appointment system for Council membership to replace the current election system.

In addition, Council voted:

for the composition of Council to be a matter for more flexible secondary legislation rather than it being fixed via primary legislation;
to an increase in the proportion of lay members, with a decision about whether Council should adopt parity of veterinary professionals and lay members to follow the consultation,
to reform its composition to remove the Veterinary Schools Council (VSC) appointees. Currently the VSC has three appointed Council members
to consult with the profession and public on two options for the future composition of a 24-person RCVS Council, which would ensure this was as balanced as possible. The first option is a Council that has a slim majority of members drawn from the veterinary professions (of whom a majority would be veterinary surgeons) compared to lay members. The second option is a Council with exact parity between veterinary professionals (of whom a majority would be veterinary surgeons) and lay members.

Council was tied on whether to separate the position of RCVS President and the Chair of RCVS Council, meaning that this will come back for decision at a later date following the consultation.

RCVS President susan paterson, said: “The unique way that RCVS Council is currently constituted with annual elections to Council is an old model of self-regulation which is no longer found in other professions including doctors, nurses, pharmacists, solicitors and social workers, among others.

“As a responsible regulator we have a duty to operate in a way that recognises modern principles of regulation, and best meets our objectives to enhance society through improved animal health and welfare by setting, upholding and advancing the educational, ethical and clinical standards for the veterinary professions.

"The College’s recommendations would see us retain self-regulation in the sense of independence from government, and maintain registrants within our governance framework, while better assuring the public that we are acting on their behalf.

“It is our firm belief that, among other things, moving to an all-appointed Council member system, whereby those who serve on Council are selected via an independent process based on their knowledge and experience to ensure input from all parts of the veterinary sector, will better serve our aims, as will having a better balance of professional and lay members.

"Of course, veterinary expertise, knowledge and experience will also remain a vital part of any future arrangements throughout our committee structure, so the veterinary voice will be as important as ever in our policy and decision-making processes.

rcvs.org.uk/who-we-are/rcvs-council/council-meetings/18-january-2024/

Further details about the consultation process will be published in due course.

Discuss here: https://www.vetsurgeon.org/f/non-clinical-questions/30878/what-do-you-think-about-the-rcvs-proposals-to-stop-council-elections-and-move-to-appointed-members-with-equal-or-almost-equal-number-of-lay-members/243481