The RCVS has opened a consultation on the future of veterinary specialisation, which includes a proposal that the use of postnominals and titles by veterinary surgeons should be rationalised in order to avoid confusion amongst the public. 

The proposals are submitted for comment by the RCVS Specialisation Working Party, which is chaired by former Chief Medical Officer Professor Sir Kenneth Calman.

The Working Party's review was precipitated by a finding that the structure of veterinary specialisation is "confusing and opaque" to both animal owners and the profession (Unlocking Potential - a Report on Veterinary Expertise in Food Animal Production, by Professor Philip Lowe, 2009).

The Working Party has explored the routes to RCVS Recognised Specialist status. It has also looked at the use of 'specialist' more broadly, given the fact that it is not a protected term in the veterinary field, and has considered animal owners' expectations of a 'specialist'. 

The Working Party also makes proposals for encouraging more veterinary surgeons to become specialists, given that there are currently only 319 on the RCVS List of Recognised Specialists, out of a UK practising arm of the profession of some 17,400 veterinary surgeons.

The proposals from the Working Party could have far-reaching impact. One suggestion is that all those meeting the criteria for specialist status would also become Fellows of the RCVS (FRCVS) - a status currently only held by those who complete a thesis or exam, or who qualify on the basis of 'meritorious contributions to learning'. There are also proposals that the term 'RCVS Recognised Specialist' be dropped and replaced with the much simpler term 'specialist' or 'veterinary specialist'.

Further proposals include the introduction of a 'middle tier' of veterinary surgeons - potentially to be called 'advanced practitioners' - who would be below full specialist status and subject to periodic revalidation.

There are also recommendations that veterinary surgeons should be obliged to explain referral options to their clients, including the level of expertise of those to whom they are referring cases.

The future of the RCVS subject boards, which currently manage the various Certificate and Diploma examinations, is also considered in the proposals.

The emphasis throughout is on simplification and improvement, according to Professor Sir Kenneth Calman, who said: "New legislation to introduce statutory registration for veterinary specialists would no doubt make things clearer, as it is for doctors and dentists, but, in the meantime, we believe there are a number of actions which the RCVS could take to improve matters."

The consultation paper can be downloaded from www.rcvs.org.uk/consultations, and comments are welcomed from members of the public, veterinary surgeons and veterinary nurses. The closing deadline for comments, which should be sent to RCVS Head of Education, Freda Andrews, on f.andrews@rcvs.org.uk, is Friday 9 December.

Comments received will be considered by the RCVS committees and Council in early 2012.

The RCVS has announced the results of the 2013 Council and Veterinary Nurses Council elections.

4,661 veterinary surgeons voted, the highest turnout seen in ten years. 1,329 veterinary nurses voted, the highest ever number.

Veterinary surgeons voted incumbents Christopher Gray, Peter Jinman, Bradley Viner, Christopher Tufnell, and Jeremy Davies back onto the RCVS Council. However, the highest number of votes was given to Thomas Witte, who will be new to Council when he takes his seat in July. Veterinary nurses voted similarly by returning Andrea Jeffery to VN Council, whilst giving to Amy Robinson, another newcomer, the largest number of votes.

According to the College, turnout in both elections has increased markedly on last year in both absolute and proportional terms. Votes were cast by 4,661 veterinary surgeons (18.8%) and 1,329 veterinary nurses (12.5%), compared to 3,625 (15.1%) and 743 (7.5%), respectively, in 2012. 

Gordon Hockey, RCVS Registrar said: "We're delighted with the increase in turnout. It's difficult to pinpoint the reasons for the increase, but hopefully, it's because increasing numbers of vets and nurses are feeling more engaged with the College. We have also undertaken extra communications activities this year, such as the 'hustings', which we hope have helped."

The Council election 'hustings' was a new venture this year, with RCVS Council candidates able to select three questions, submitted by voters, to answer in a live webinar run by The Webinar Vet.

Veterinary surgeons and VNs could cast their votes by post, online, or by text. The majority of vets voting chose to cast postal votes (3,247), as did the majority of VNs (1,055). Whilst voting online was used by 1,330 veterinary surgeons, only 227 VNs chose it as a means of voting. Voting by text was used by only 84 veterinary surgeons and 47 VNs.

The successful candidates will take up or resume their seats at RCVS Day on 5 July.

The full results of the two elections are as follows:

RCVS Council election

WITTE, Thomas Hermann - 2,251 (Elected)
GRAY, Christopher John - 1,974 (Elected)
JINMAN, Peter Charles - 1,949 (Elected)
VINER, Bradley Phillip  - 1,927 (Elected)
TUFNELL, Christopher Wynne - 1,883 (Elected)
DAVIES, Jeremy Vincent - 1,830 (Elected)
STURGESS, Christopher Paul - 1,809   
CONNELL, Niall Thomas - 1,596   
ROBINSON, Peter Bayley - 1,366   
ELLIS, Robert Nigel Ward - 1,302   
GRANT, Lewis George - 832   
TORGERSON, Paul Robert - 824   
LONSDALE, Thomas - 337   

Twenty-two votes in the RCVS Council election were found to be invalid.

VN Council election

ROBINSON, Amy - 725 (Elected)
JEFFERY, Andrea Karen - 607 (Elected)
BADGER, Susan Frances - 459
TOTTEY, Helen Wendy 332   

One vote in the VN Council election was found to be invalid.

The 2013 RCVS and VN Council elections were run on behalf of the RCVS by Electoral Reform Services.

The RCVS Disciplinary Committee has dismissed a case against a Southampton veterinary surgeon after finding him not guilty of serious professional misconduct, saying at all times that he acted in the best interests of a dog under his care.

At the start of the five-day hearing, the charges against Edward Gillams MRCVS were that, whilst in practice at Vets Now in Southampton in 2011, he discharged a dog that he knew or ought to have known was in no fit state to be discharged, and, at the same time, failed to provide adequate advice and information to the dog's owners, particularly with regard to an alternative plan to discharge and treatment options.

The dog, an Italian Spinone called Zola, had first been taken to the Vets4Pets veterinary clinic in Southampton at 4.30pm on 2 November 2011, where gastric torsion was diagnosed. During a subsequent gastrotomy, 3kg of sausages and plastic wrappings were removed. Zola was discharged three days later, with a guarded prognosis from the operating veterinary surgeon. Zola's condition deteriorated that same evening, so his owners called the Vets4Pets practice and were referred to their out-of-hours provider, Vets Now, where Mr Gillams was on duty. On admitting Zola, the only information available to Mr Gillams was what the dog's owners were able to tell him.

The Committee heard differing witness accounts from the dog's owners and from Mr Gillams regarding what tests and examinations were to be performed, and what advice and options were suggested. Ultimately, Zola was hospitalised overnight (despite some reluctance for this from one of his owners), given pain relief and antibiotics and placed on a drip; he was then to be collected by his owners first thing for transfer back to Vets4Pets. The next morning, Zola was described as 'sternally recumbent but responsive', holding his head up but not moving and not making any attempt to get up. Mr Gillams carried Zola to his owner's car for transport back to the Vets4Pets practice. He considered that he had discharged his duty to provide advice, as this was given the night before and in the circumstances prevailing in the morning there was no obligation to repeat this. Zola died on the journey between the two practices.

Before reaching a decision, the Committee considered, in detail, the expert evidence of witnesses for both the College and Mr Gillams, which provided some conflicting views on Mr Gillams' actions. It also referred to the RCVS guidance available to Mr Gillams at the time through the RCVS Guide to Professional Conduct 2010.

The Committee noted that both experts agreed that Mr Gillams could not have known Zola was about to die when he discharged him and that it was a difficult decision for Mr Gillams to make, but expressed differing views about the fitness of the dog to be discharged and whether it was in its best interests to be discharged. The Committee rejected the contention that Mr Gillams ought to have known that Zola was not fit to be discharged, and instead considered appropriate his decision to discharge him into the care of his original veterinary surgeon. It felt that continuity of care would actually be better maintained in this manner, rather than a third veterinary surgeon taking over the case.

Regarding provision of adequate advice, the Committee accepted Mr Gillams' evidence that he was frustrated that the owners refused him permission to undertake the diagnostic work necessary to treat Zola effectively, and that he had no other clinical information to work with.

Chairing and speaking on behalf of the Disciplinary Committee, its Vice-Chairman, Ms Judith Webb, said: "The Committee expresses its sincere condolences to [the owners] for the loss of their much loved family pet Zola and recognises that this loss caused the family great distress."

Ms Webb added: "The Committee accepts that [Mr Gillams] discharged his obligations to Zola and to [his owners] in a manner wholly consistent with the standards of a competent veterinary surgeon in difficult circumstances. He leaves with no stain on his character or professional ability."

The full detail of the Committee's decision is available on the RCVS website (www.rcvs.org.uk/disciplinary).

In a landmark disciplinary case last week, Staffordshire-based veterinary surgeon Roger Meacock MRCVS has undertaken to amend his website after the College alleged it contained content which was either misleading or inaccurate to the point of bringing the profession into disrepute.

Mr Meacock faced six charges relating to his website - naturalhealingsolutions.co.uk - which has claimed, amongst many other things, that:

• e-Lybra9 Bio-Resonance Technology reveals weaknesses in the immune system and strengthens it to increase resistance to disease;
• Quinton Marine Plasma allows the body to recover from a wide range of medical diseases;
• the specific properties of the localised environment created by the Russian Healing Blanket around the patient’s body provide the desired activation of the body’s self-regulatory and self-recovery mechanisms;
• Aerobic Oxygen has been found to have a wide range of health benefits;

VetSurgeon.org understands this is the first time that claims made on a practitioner's website have been the subject of a disciplinary hearing. However, before the case could be heard and the claims tested, counsel for the College and the defendant met in private, whereupon Mr Meacock voluntarily entered into undertakings with the RCVS to amend his website in order to make it compliant with his professional responsibilities.

As a result, the College applied to adjourn the hearing generally (ie indefinitely). This application was not opposed by Mr Meacock and was granted by the Committee.

Judith Webb, chairing the Committee and speaking on its behalf, explained that the adjourned charges would be kept open indefinitely but the Committee encouraged the College not to extend the period beyond two years. However, if at any time in the future Mr Meacock failed to keep up his undertakings or made further claims which the College found unacceptable, then a fresh case could be brought.

Because Mr Meacock's undertakings were agreed in private, it is not yet known whether he has agreed to remove all of the content on his website alleged by the College to bring the profession into disrepute, although presumably time will tell.

In addition, it is not clear whether Mr Meacock also undertook not to practise those treatments which the College claimed bring the profession into disrepute (as opposed to just advertising them on his website). 

Either way, the implications of the case could stretch beyond Marine Plasma, Russian Healing Blankets and Bio-Resonance Technology. In particular, it raises a serious question over the unsupported claims being made by other practitioners of alternative and complementary therapies, such as the claim by the British Association of Homeopathic Veterinary Surgeons that homeopathy is effective in resolving cancer: http://www.bahvs.com/cured-cases/.

The Committee's full findings and decision are available here.

The Royal College of Veterinary Surgeons has announced the results of the 2011 RCVS and VN Council elections.

Elected to the RCVS Council are:

• Professor Sheila Crispin (2281 votes)
• Professor Sandy Trees (2,247 votes)
• Bob Moore (1,890 votes)
• Mark Elliott (1,821 votes)
• Lynne Hill (1,711 votes)
• Beverley Cottrell (1,604 votes)

Not elected are:

• Jonathan Bray (1,494 votes)
• David Mason (1,358 votes)
• Adi Nell (1,163 votes)
• Tom Lonsdale (363 votes)

For the first time in eight years, all six successful RCVS Council candidates have served on Council before, although one - Sandy Trees - is currently an appointed, rather than an elected, member.

For VN Council, one existing member has been returned and two new members have been elected:

• Elizabeth Branscombe (430 votes)
• Elizabeth Cox (335 votes)
• Tanya Caley (332 votes)

Not elected to VN Council was:

• Rachel Smith (328 votes)

Following rises in previous turnouts, voting figures have dropped markedly this year in both RCVS and VN Councils elections, to 15.9% (3,887 voters) and 7.6% (723 voters) respectively. The previous turnouts were 18.8% (in 2010) and 11.2% (in 2009).

RCVS Registrar Jane Hern said: "It's certainly disappointing that the turnout has dropped so much this year. It's unclear whether this is due to lack of time, lack of awareness, or lack of interest, but perhaps anyone who didn't vote could let us know why, so we can see what we could do to increase participation.

"Nevertheless, my congratulations to all successful candidates, who I look forward to formally welcoming, or welcoming back, onto the Councils at RCVS Day in July, and my commiserations to those who were unsuccessful this time and who I hope won't be discouraged from standing again next year."

This year's chosen charity - the Veterinary Benevolent Fund - will receive a cheque for £922 arising from the College's pledge to donate 20p for each veterinary surgeon and veterinary nurse who cast a vote.

Veterinary surgeons can now cast votes for their preferred candidates in this year’s RCVS Council election. 

• Dr Niall Connell MRCVS
• Dr Joanna Dyer MRCVS
• Dr Professor Tim Greet FRCVS
• Dr Lynne Hill MRCVS
• Dr Richard Hillman MRCVS
• Dr Heidi Janicke MRCVS
• Dr Hannah Jordan MRCVS
• Dr R.M.B. (aka Thomas) Lonsdale MRCVS
• Dr James Main MRCVS
• Dr Katherine Richards MRCVS
• Dr Peter Robinson MRCVS 

Vet Futures, the joint initiative by the RCVS and BVA to stimulate debate about the future of the profession, has opened a new discussion about whether VAT on vet fees for pets should be dropped.

The discussion has been opened by this month's Vet Futures guest blogger, Stuart Winter, the Sunday Express small animal columnist and a campaigner to end VAT on pet fees.

Stuart argues that owning a pet is not a luxury to be taxed when they need medical intervention, because owning a companion improves the health and wellbeing of its owner.

He writes that removing VAT on veterinary fees for domestic animals, or at least reducing it to five pence in the pound, would improve the nation's animal welfare. It would allow low-income families to seek medical attention earlier, he argues, while allowing more owners to afford and take out pet insurance.

He says that shifting Government thinking on the subject might be a Herculean task, but that doesn't mean we shouldn't campaign for its removal. "No Chancellor delights in losing revenue. Treating, curing and caring for sick and injured animals is nothing more than a service and services are ripe to be harvested.

"It is time for a counter argument. Pet ownership is not a luxury. It is more than a privilege. Is it not a human right? Welcoming animals into our lives makes our lives more fulfilled and more civilised."

To tie in with the discussion, Vet Futures is inviting vets to take part in a poll which asks: "Would you agree that VAT should no longer be levelled on vet fees?"

The College is encouraging members of the veterinary team and the public to take part in the poll so that it can generate debate on the issue of VAT and better understand the full consequences if it was removed.

January's poll asked members of the profession if they could recognise the signs of mental ill-health in a colleague. Reassuringly, just over half (58%) of the 65 respondents said they would be able to recognise the signs, although that leaves 40% who would not feel comfortable in their ability to do so.

To read Stuart Winter's blog, contribute to the discussion and vote in the poll, visit www.vetfutures.org.uk

The RCVS has advised that veterinary surgeons should delegate Schedule 3 work to veterinary nurse students only during students' training, following a series of queries from employers about such students locuming.

Veterinary surgeons have dispensations under Schedule 3 of the Veterinary Surgeons Act to delegate to student veterinary nurses in the course of their training, so that students can learn how to give medical treatments to animals.  

Crucially, these dispensations apply only when the student is working as a student in their approved training practice or on a placement organised by their university, and is under the supervision of qualified staff.  

These dispensations do not apply to any extra-curricula activity so, if working as locums, they are legally classified as unqualified lay staff

The RCVS is concerned that locum agencies do not always appear to know this and are placing locums in their capacity as students, or even "senior students." This has the potential to mislead employers and the students concerned, and result in illegal practice.

Liz Branscombe, Chairman of the RCVS Veterinary Nurses Council said: "We know that student VNs, especially those on university courses, often undertake locum work to supplement their earnings. However, beyond the training practice which employs them, or in a placement organised by their university, they can only carry out tasks that may be expected of an unqualified staff member, and cannot legally undertake Schedule 3 work."

Practices may check the details of a student VN directly with the RCVS or with the student's college. If you notice an agency promoting student VN locums, please contact the RCVS so that we can provide guidance.

The RCVS has launched a new College honour, the RCVS Queen's Medal.

RCVS President Col Neil Smith said: "The Queen's Medal will be the most prestigious honour that the RCVS can bestow upon a veterinary surgeon and will be reserved for those whose distinguished careers and outstanding lifetime achievements deserve wider recognition."

The honour was created following a review of the RCVS honours system, which demonstrated the need for a new aspirational award.

The RCVS wrote to the Cabinet Office last year, together with letters of support from Peers and MPs, many of whom attended the reception, to request permission to name this new honour after Her Majesty the Queen.

Col Smith said: "We are honoured that Her Majesty has supported the proposal and allowed the College to name the award after her, and express our sincere thanks to those Parliamentarians who supported our endeavour."

The first RCVS Queen's Medal will be presented at RCVS Day in July 2014. The nomination form for the Queen's Medal can be found at www.rcvs.org.uk/Queensmedal.

The Disciplinary Committee has directed that Kfir Segev be restored to the RCVS Register, having removed him over two years ago for dishonesty and misleading clients.

Mr Segev, formerly practising in Stanmore, Middlesex, was removed from the Register following an 11-day hearing ending on 19 May 2009 at which he had been proven guilty of deliberately concealing from his clients that their dog was terminally ill, whilst at the same time recommending that she undergo expensive and unnecessary procedures. 

This was Mr Segev’s first application for restoration to the Register. The Committee found that, during his period of removal, he had undergone “extensive personal and professional rehabilitation”, which included attendance at a clinical psychologist and voluntary work in the local community.

The Committee found that, during his period of removal, he had undergone "extensive personal and professional rehabilitation. 

From 2009 to September 2011, Mr Segev logged 420 hours of certificated continuing professional development, with particular emphasis on ethics, client relationships and animal welfare.

The Committee noted he had also seen practice and taken the advice of mentors, including about 80 days at “a number of high quality practices with eminent members of the profession”.

These included Professor Dick White MRCVS, of Dick White Referrals, Professor David Noakes FRCVS, Emeritus Professor of the Royal Veterinary College and Mr David Grant MBE FRCVS, Hospital Director at the RSCPA Sir Harold Harmsworth Memorial Hospital, all of whom gave evidence at the hearing in support of Mr Segev.

Professor White said that, since late 2009 when he was approached by Mr Segev for help in remedial training, continuing education and mentoring, he had subsequently had frequent dealings and conversations with him.

Professor White said: “I formed the opinion that he invariably exercised professional clinical judgement that is, if anything, considerably deeper than many professional colleagues. I felt he demonstrated compassion for patients and empathy for owners in equal measure and believed him to have come to understand fully the seriousness of his behaviour."

Mr Segev’s efforts at rehabilitation were described as “exceptional” by Professor Noakes, who said he was “impressed by Mr Segev’s genuine acceptance of the fact that he had committed a serious offence and deserved to be punished.”

Mr Grant, who had been in contact with Mr Segev since November 2010, told the hearing that, in his opinion, it was most evident that Mr Segev accepted his wrongdoing and, along with Professor Noakes, indicated that he was willing to offer continued support and help.

The College opposed the restoration of Mr Segev on three grounds, namely: the gravity of the matters found proved at the original hearing; that the length of time off the Register was insufficient to mark these and ensure that the reputation of the profession was not undermined in the eyes of the public; and, Mr Segev’s conduct, relying on two matters arising from the footage in a BBC Panorama programme, which was filmed both before and after the 2009 hearing.

The College also questioned whether Mr Segev genuinely accepted the original findings.

The Committee agreed that the findings of the original hearing were serious; it was, however, impressed by Mr Segev’s complete and genuine written and public apologies for what he had done.

It disagreed that the length of time off the Register was too short.

It was mindful that the purpose of the sanction of erasure is not primarily of punishment and considered that no useful purpose would be served by delaying further Mr Segev’s restoration.

Whilst the Committee found Mr Segev was wrong to have continued to display ‘veterinary surgeon’ on the practice nameplate (as shown in the television footage), it was satisfied that he did not intend to hold himself out as a practising veterinary surgeon and no harm to the public or animal welfare resulted from his mistake.

The footage also showed Mr Segev was in breach of RCVS guidance on the administration of anaesthesia by permitting a student veterinary nurse to induce anaesthesia by using incremental doses of intravenous propofol, with an unqualified assistant offering advice on the depth of anaesthesia during its incremental induction. The Committee considered Mr Segev’s actions to be an error, now cured.

In conclusion, the Committee accepted Mr Segev “had made genuine and successful attempts to reform his previous attitude and failings”.

It noted that a large number of testimonials had been provided by colleagues, friends and clients, and that the impact of removal on Mr Segev had been severe.

It concluded that his previous mistakes provided “no reason, relevant to animal welfare, to suggest that his restoration would be unwise.”

Speaking on behalf of the Committee, Chairman Beverley Cottrell said: “Restoration to the Register of a veterinary surgeon who has been guilty of disgraceful conduct in a professional respect of such seriousness is not something to be undertaken lightly … But, in all the circumstances of this case, [we have] decided that Mr Segev is a fit person to restore to the Register, and so direct the Registrar.”

The Royal College has announced the winners of the 2009 RCVS Council and VN Council elections.

This year, a special elections section was set up here on VetSurgeon.org and on VetNurse.co.uk for members to engage directly with candidates in a members forum, or directly using the social networking features on both sites. In the interests of promoting democracy, the sites offered a case of champagne to the voter who started the forum discussion which generated the greatest number of responses. Over the course of the voting period, these sections received over 23,000 page views, 53 questions for candidates, and 650 responses.

Arlo Guthrie, Editor of VetSurgeon.org and VetNurse.co.uk said: "I think it's great that the candidates agreed to try this. They could have said no, and stuck with the traditional methods of communication (which are more of a known quantity). Instead, they really got stuck in to some interesting and at times lively debate. My sincere thanks to all candidates and congratulations to the winners. And I raise my glass to Phil Elkins, who wins the case of champagne for starting the most active discussion thread, even allowing for the number of times he responded to his own post!"

Voting in the RCVS Council election increased from 17% to 18.2% this year, with 4,041 veterinary surgeons out of a possible 22,201 casting a vote. The results are as follows:

NUTE, Patricia Jill. 2,467 votes. Elected
JINMAN, Peter. 2,346 votes. Elected
GRAY, Christopher John. 2,230 votes. Elected
DAVIES, Jeremy Vincent. 2,229 votes.  Elected
VINER, Bradley. 2,123 votes. Elected
TUFNELL, Christopher Wynne. 2,088 votes. Elected
SWAYNE, Nigel. 1,673 votes. 
McDOWELL, David Michael. 1,394 votes.
LONSDALE, Thomas. 389 votes.

The new Council members are Christopher Gray and Christopher Tufnell, who will officially join Council at RCVS Day on 3 July 2009.

The VN Council elections saw a larger increase in voters, with 912 out of a possible 8,108 VNs casting a vote. This was an 11.2% turnout, up by nearly 25% up on last year. The results were as follows:

JEFFERY, Andrea Karen. 604 votes. Elected
GLYSEN, Louise. 332 votes. Elected
WILLIAMS, Caroline Mary. 312 votes.
IVES, Cheryl Diana. 236 votes.    

Louse Glysen is the new VN Council Member (again, officially joining at RCVS Day) and Andrea Jeffery will begin her eighth year, having been the Council's chairman for the past four years.

A motion to conduct a trial of remote prescribing without performing a physical examination (ie. via telemedicine), thereby redefining what it means for an animal to be "under the care" of a veterinary surgeon, was put before RCVS Council last week. I was there to hear the arguments …

The motion was introduced by Kate Richards MRCVS, Chair of the RCVS Standards committee, who explained that it'd been driven by three things, namely: the Vet Futures Initiative, the RCVS Strategic Plan signed off by Council in 2017 and the RCVS telemedicine consultation that took place earlier this year. 

The latter of these showed that 69% of vets opposed the idea of prescribing without a physical exam, which rather beggars the question why it's being discussed at all. However, as Kate explained, when asked whether certain types of products could be remotely prescribed, the answer was more equivocal: 52% of vets said "yes".

Kate also explained that over the last two years, there had been a number of good quality discussions at Standards Committee and Council, but that decision-making had been "hampered by a paucity of evidence on the opportunities, risks and benefits of telemedicine to animals and the public".

The full wording of motion was: "Council is invited to consider the recommendation of Standards Committee to conduct a limited and time-bound trial to assess the benefits and risks of allowing the remote prescription of POM-V (excluding opiates, sedatives and potentially also critically important antibiotics) where there has been no physical examination."

However, in order for the trial to take place, it would be necessary to make a temporary change to the Supporting Guidance of the Code of Professional Conduct concerning the definition of "Under his care" (Ed's note. C'mon RCVS, isn’t that a bit anachronistic? Both your CEO and your President are now "her". "Under Care" would do it.), adding the words in italics to para 4.1: "A veterinary surgeon cannot usually have an animal under his or her care if there has been no physical examination; consequently a veterinary surgeon should not treat an animal or prescribe POM-V medicines via the Internet alone, other than in circumstance where a telemedicine service is a part of the RCVS telemedicine trial".

In the best interests of animal welfare

Amanda Boag (MRCVS, Vets Now, RCVS President) then reminded everyone that: "RCVS Council needs to act in the best interest of animal welfare and the public, and whilst sustainability of veterinary services is important, it isn't our role to promote anything novel or to protect traditional models."

Really? Strikes me that the sustainability of veterinary services isn’t just "important", it's an essential part of ensuring good animal welfare. Surely, therefore, it most certainly is the role of Council to protect traditional business models or, for that matter, to promote novel methods if (and I stress "if") doing so protects or enhances animal welfare.

Don’t confuse telemedicine with remote prescribing

Jo Dyer (MRCVS, small animal locum, Devon) opened by pointing out that this is not about telemedicine per se. Telemedicine has been going on since the invention of the telephone in the late 1800s, supplemented over the last 20 years or so by photography and video sent over the internet. Telemedicine does not, in and of itself, require a change in regulation.

What this is about, she explained, is the much narrower act of remote prescribing without physically examining the animal, something which would require the profession to redefine "under his care", which in turn "makes up the foundation of what forms the relationship with the owner and the animal in order that we can safeguard the use of medicines, safeguard the animals under our care and safeguard our clients."

No evidence remote prescribing increases access to veterinary services

Jo argued that the only reason Council should be considering the prescription of medicines without a physical examination would be if it were in the interests of animal welfare. And yet, she said, there is no evidence to support this idea.

Some have suggested that it could increase access to veterinary care. However, Jo said she had been unable to find any evidence to support this idea either. Not just in the veterinary profession, but in the medical profession in the Western and the developing world.

Jo also noted that the trial proposal was to use commercial organisations which have a financial interest in a positive outcome, which would render the results biased and unreliable.

She then raised the issue of antimicrobial resistance, highlighting the use of cytology and culture sensitivity to make sure the right antibiotics are used. Remote prescribing, she said, would be a retrograde step, even if only non-critical antibiotics could be prescribed remotely.

Spawning a new class of limited service provider

Next she highlighted the impact of the trial on 24-7 cover. Under the proposal, "Those under a trial would be required to actively support clients in identifying a veterinary practice that could physically see their animal in both routine and emergency situations."

As Jo pointed out, this would by definition mean that any veterinary surgeon, not just those practising telemedicine, could set themselves up as a limited service provider and refer all cases they didn’t want to see (whether OOH or not) to a local practice. This, she argued, should only happen after a proper debate, and not be just the unintended side-effect of regulation change to allow remote prescribing.

In fact, there is evidence that this is exactly what is happening in human medicine. Only the following evening, the BBC aired Diagnosis on Demand: The Computer Will See You Now, a documentary about telemedicine and artificial intelligence in human medicine. It should be required watching for all RCVS Councillors.

The programme makers visited GP at Hand, a telemedicine business based on the Lillie Road in Fulham, London that has been formed in partnership with Babylon. Coincidentally just up the road from where I used to live, it's a pretty nondescript sort of a place, but now home to the fastest-growing GP surgery in the UK. Since late 2017, it has amassed a staggering 30,000 clients from across London, virtually none of whom will ever visit the place. The problem is that GP at Hand has skimmed away fee-paying clients from across the capital that had in effect been helping to subsidise local care elsewhere.

More information needed for such an important decision

Jo concluded by saying that a decision of this magnitude, particularly when it seems to go against the wishes of the majority of the profession, demands checks to ensure no conflicts of interest, legal advice and wider consultation with organisations such as the VMD, Defra, the BVA and its subdivisions and the VDS. Therefore, she would propose a new motion to delay the decision until more information is made available.

Chris Barker (MRCVS, small animal practice, Cumbria) was up next. He felt that the RCVS consultation was very effective and gave a good picture of what veterinary surgeons see as the risks inherent in remote prescribing. However, he felt that the analysis has been marshalled to suit an agenda and minimises the concerns of general practitioners.

Fragmentation and multiple consultants leading to a loss of responsibility

The trial, he said, will lead to fragmentation of veterinary provision and send the message to the public that it is quite OK to go to more than one vet for advice and treatment, and that will lead to confusion and the loss of individual responsibility for the veterinary care of an animal that exists today.

An inspection with no history: not a proper examination.

Chris argued that the act of prescribing demands a physical examination, but that a video consultation could only ever be an inspection. He also highlighted the importance of patient histories and argued that the immediacy of telemedicine simply doesn’t allow a practitioner to get the patient history from another vet.

Chris also argued that the profession is not structured to allow for clients to consult multiple veterinary service providers simultaneously: once a client leaves his practice, he has a duty under GDPR to expunge much of their records, and he for one didn’t much care for the idea of re-registering a client at 2:00am.

Some of the issues Chris raised may of course be solved by technology in the foreseeable future. GDPR already calls for data portability, presumably it will not be long before owners expect the same data portability for their animals' clinical histories.

Who wants clients who only ever call when telemedicine has failed?

Still, his overall point was an important one: whether or not there will be vets out there who are happy to pick up and see failed telemedicine cases at 3:00am in the morning from people who are not clients of their practice and who don’t otherwise contribute financially to the business.

90% of vets say remote prescription is high risk or inappropriate

Lastly, Chris drew attention to a question in the RCVS consultation which asked respondents what risk they thought there would be in a remote consultation when the consulting vet did not know the owner, did not know the animal and does not know the situation in which the animal is kept: "90% of responding veterinary professionals either chose it as high risk or simply not appropriate at all. I know of no better body of people than practitioners in Britain to understand the welfare and the risk to the welfare of animals."

The risk of misdiagnosis

Martin Peaty (MRCVS, equine practitioner, Wiltshire) spoke next, highlighting the risk he saw to animal welfare from misdiagnosis. He drew attention to concerns raised by the Quality Care Commission in human medicine, in particular that there is no access to the long term medical records of the patient, and the risk of misdiagnosis: "And that’s in human patients who can fluently articulate their symptoms", he said, "I think we should be much more cautious in exercising care before allowing remote diagnosis and prescription."

Martin's point seemed especially apposite in the light of an article which appeared in The Times two days later: 'NHS app 'no match for trip to the GP', in which Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs expressed concerns about online consultation systems, particularly for vulnerable groups, such as children.  

Remote prescribing demands that vets sacrifice principles

Martin also outlined the three principles which underpin current practice: physically examining the animal, considering its history and providing 24 hour care, the latter in part in case of a reaction to a prescribed medicine.

"These proposals ask us to sacrifice these principles for telemedicine businesses whilst for good reason they remain in place for other veterinary practices. I think that is hypocritical. I think it is wrong."

Not enough follow-up

Sue Paterson (MRCVS, a referral specialist who offers a dermatology telemedicine service to the profession and the public, Merseyside) jumped in next. She was unashamedly enthusiastic about the benefits of telemedicine, in particular how it allows practitioners to engage with the public and make veterinary advice more accessible, not to mention because: "I am sick to death of people coming into consults when they have been on Facebook or they’ve been on to talk to Dr Google."

However, despite her enthusiasm and despite finding that users of her service do not want antibiotics, just advice, help and reassurance from people they trust, Sue was still against the idea of remote prescription: "I don’t want to prescribe because I can't follow those cases up, because I can’t maintain the level of client care that I think is really important, so for me, I would not want to see this change to the code."

We won’t know what we missed, or the consequences of what we missed

Caroline Allen (MRCVS, charity veterinary director, London) said the biggest issue for her is that without a physical examination, she won’t ever know what she missed (the heart murmur, the goitre, the subtle muscle wastage), or for that matter, the animal welfare consequences of what she missed.

As others had done, Caroline highlighted the importance of getting a weight every time and how difficult it is for clients to measure accurately.

Lastly, she made the thought-provoking point that allowing the remote prescription of drugs without a physical examination would risk legitimising Dr Google in the eyes of the public. After all, if no veterinary physical exam is needed, surely owners can just look it up on the internet for themselves?

In defence of the RCVS

At this point in the discussion, RCVS CEO Lizzie Lockett addressed the suggestion that the whole process of investigating and voting on telemedicine was being driven by hidden agendas, something she absolutely and eloquently rejected. She explained that sure, some parties had been more engaged in the whole process than others, but emphatically denied there had been any influence. Council, she said, had asked Standards to investigate and develop a proposal, which it had done diligently. Now it is down to Council to decide whether the proposal stands or falls; the College exists to implement the decision.

RCVS Vice President, Professor Stephen May went further, saying that many present would be aware that he'd been a vocal critic of the way that a number of other regulators in modern society push things out to court for decisions, rather than taking decisions collectively and then sticking by them. "I’m really proud that we are discussing this and I’m really pleased that this is up to us how we move things forward in the interest of animal health and welfare and supporting the public in that."

The need for a more nuanced, less polarised debate

However, he said he was worried about the way the debate was being polarised into a yes or no when he felt the profession should thinking about how it should adapt to the changing circumstances, thinking about cases which are amenable to a distant relationship and in what context that is appropriate, taking into account the risks. 

Remote prescription is already happening, illegally

Melissa Donald (MRCVS, small animal practice, Scotland) questioned whether telemedicine and remote prescription is what the public wants. She said that remote prescription is already happening, illegally from abroad, and that the College needs to have a more robust response than "it’s not our problem". She therefore recommended a further period of consultation, particularly with public focus groups, and internet research to see how much remote prescription is already happening. 

Vets are professionals

Tim Walker (Lay) said he was struck by the need to assemble better evidence. He felt there needs to be more thought given to the transference of responsibility for cases between a telemedicine provider and a traditional practitioner. Tim also felt that the definition of "under his care" will almost certainly need to be rethought in the not-too-distant future, because the idea of a patient being under the care of just one practitioner is starting to look dated; in the human sphere, patients are looked after by teams of people.

Tim highlighted the approach he said is taken by the GMC, which obliges doctors to be able to demonstrate that they have done sufficient due diligence to prescribe, not that they can simply do so automatically under certain circumstances. That, he said, is what professionalism should be about.

Taking the lead

Mark Castle (Lay) said he thought that the public was looking for a choice, that technology is constantly throwing up new opportunities, and he expected that in the future more and more will be able to be done remotely, so he wanted the RCVS to take the lead in this area.

Lucy Goodwin (MRCVS, BSAVA Head of Education) was positive about the idea of conducting a time-limited, controlled trial: "We say we want evidence, so let’s go and collect it", but had a number of reservations. Not least of these was the fact that the participants in any trial would be on best behaviour, so it may not be able to extrapolate the numbers to the profession at large. Beyond that, she was also concerned that the scope of the trial should be better defined, in particular which categories of drug could be included within it. 

Vets don't want a trial of telemedicine

Mandisa Greene said that whilst she is positive about telemedicine as it had been described, and not averse to a trial, she didn’t see the point in a trial when the people who actually do the prescribing don’t want it. 

A voice in favour

Chris Tufnell (Past President) began by declaring that he consults to the Affordable Pet Care Company which is shortly to launch a telemedicine service, although he said the service would be unaffected by the decision being taken by Council. He was also at pains to stress that he hadn’t had any other fingers in this particular pie, in particular that he hadn’t been to any of the Standards Committee meetings or presented to them, or been involved in formulating the proposed trial.

Whether you agree or disagree with Chris, it was at least good to hear someone speaking in favour of the motion. Chris opened by arguing that veterinary surgeons are good at making decisions based on imperfect information: "Client histories, as we know, are of variable quality. We make decisions daily on whether we are happy with the information we get from the practice lab or whether we need to send the sample to a reference lab. When I started in practice, practice lab machines were routinely described as random number generators."

"We make decisions on a daily basis on what the limitations of our abilities are. It’s called professional judgement and what we are proposing here is actually a test of our definition of 'in our care'. We’re talking about testing the possibility of making remote prescriptions. The responsibilities around prescribing won’t change, and those responsibilities include the responsible use of antibiotics."

Chris then argued that all the motion was calling for is a trial of something that unlike, for example, deregulating advertising and practice ownership, is not going to give a slice of the consultation fee to non-vets. He also pointed out that people will always be able to highlight cases that would be completely unsuitable for remote prescribing, but that this is not about replacing the consulting room.

Filling the void

What it is about, he said, is removing barriers to care; filling the vacuum between a concerned owner, and the £60 - £100+ they’ll be charged for a consultation. It’s a vacuum that is currently filled by the 'free' (except it's not) phone advice given out by practices, by Facebook and by Dr. Google. 

He then pointed to an example from the US, where 83% of people who visited https://www.whiskerdocs.com for pet advice and thought their problem was suitable for home treatment, were in fact wrong and ended up being instructed to visit their veterinary practice. This, he said, could lead to better productivity in practice.

Could telemedicine help retention?

Telemedicine, he said, could also provide a role for people thinking of leaving practice, which is potentially an important factor at a time when retention is proving such an issue. 

Evidence-gathering, clinical freedom and professional judgement

Like others, Chris argued that the trial is about putting the RCVS at the forefront of progression in our increasingly digitised society, at a time when remote information from wearables is going to become more and more common. In summary, he said: "This trial is about an evidence-based profession looking for evidence, it’s about clinical freedom and it’s about putting professional judgement in the hands of the professionals."

A two-tier service

Lynne Hill (Past President) said her main concern is about having to redefine "under his care" and how remote prescribing via telemedicine would lead to a two-tier level of care, which she thought would be wrong.

She also highlighted that the College had debated the definition of "under his care" in relation to farm animal practice, where some farmers have multiple vets, some of which offer herd health care and nothing else. Deregulating to account for this has, she said, been responsible for the demise of farm animal practice. Quite simply there are less vets around to see animals. 

Show me the money

Lynn also noted the altruistic nature of the debate thus far, and reminded everyone that this is really about business and making money. The companies that are set up to provide telemedicine and possibly take part in the trial will not be in it for the welfare of animals, but to make money.

She also scoffed at the idea that telemedicine and remote prescribing will mean the 10% of people who do not currently have a vet are "now going to get madly involved in telemedicine." The reason they don’t have a vet at the moment, she said, is because they don’t want to pay. Telemedicine doesn’t change that. 

Lastly, as others had done, she highlighted the difference between human medicine, where patients can describe their symptoms, and veterinary medicine, where they can’t.

Leadership is about taking the right decision, not jumping on the bandwagon

"Leadership is not always about jumping on the bandwagon and going forward because something is out there. Leadership is actually about looking and deciding and making the right decision."

The disingenuous antimicrobial argument

Dave Leicester (MRCVS) was up next, arguing that it would be wrong to say that a body of professionals can be trusted to make decisions about animal welfare, but not about prescribing. He also felt it was a little disingenuous to do a lot of hand-wringing over antimicrobials when, as a profession: "We’ve managed to make a 3rd generation cephalosporin the most prescribed antibiotic in cats."

Finally, Dave made the point that in his 15-year experience working for OOH emergency service providers, they’d managed to work very successfully without access to patient medical histories.

Setting veterinary standards

Claire McLaughlin (Lay) reiterated that the role of the RCVS is to set veterinary standards, something it can’t very well do without knowing what is going on in practice, and finding out how these things work in practice. “We need to be in a process which takes us to able to set those standards. Whether the trial that is proposed is the right trial or not, we can’t just say no, it’s fine as it is because people will work within their professional competence. As Eleanor [RCVS Registrar] will tell you, they don’t work within their professional competence because they come before disciplinary committee all the time. I think we would be remiss if we didn’t start a process now or continue this process in a way that allows us to set appropriate standards.”

Colonel Neil Smith (MRCVS, Chief Veterinary Office for the Army) began by declaring that he provides telemedicine services for animals in disparate parts of the world as part of his day job, but these animals are very much under care and there is an existing relationship with patients. He is also involved with the provision of limited veterinary services for homeless people via StreetVet, a charity which has had to form relationships with practices that can cover the 125 hours per week when it is not present. 

Lowering veterinary standards

Neil explained that his "massive" concern with the proposal lies in particular with the part that says: "Given the limited nature of the service that can be provided by telemedicine alone, however, it is proposed that those under a trial would be required to actively support clients in identifying a veterinary practice that could physically see their animal in both routine and emergency situations."

This, he said, would lower veterinary standards, if all somebody providing telemedicine has to do is point people in the direction of a practice. 

For that reason, Neil said, he could not support the proposal as is, and would instead recommend that it goes back to Standards and is then brought back at the next council meeting with a clearer idea of what the trial is all about.

Accessible care

Caroline Allen then jumped in again, saying that whilst she agreed with the idea that more data is needed, she also thought that telemedicine and remote prescription is being driven by the issue of accessible care, and it is that, in fact, which needs to be investigated and understood and debated first.

The digital age

Past President Professor Stuart Reid highlighted that the veterinary students of today live their lives in the digital environment and their world will be very different from ours. The same goes for pet owners. He reiterated that as the regulator, the RCVS needs to be ahead of the game, and that if this is what the public wants, then it has to find a way of regulating it. 

Stuart finished by saying that he felt conflicted about the vote; that he had significant problems with the proposal and is not entirely sure that a trial is the right thing, but: "In the referendum we're about to have, I want to say yes but I want to see what the deal is as well." He added: "I didn't vote out by the way, in case this gets back to my employers, but I do think we have to think very carefully about throwing the baby out with the bathwater here."

Pressure to prescribe

Martin Peaty then recounted how at a Vivet Conference last year, a provider of telemedicine (which he thought was Babylon) explained that doctors on its system were retained on the basis of a post-consultation customer satisfaction survey. That, he thought, would make it difficult for practitioners not to prescribe things when they know it will affect their job. 

David Bray (Lay), said he believed the telemedicine and remote prescribing will come and it will become more common to have pets treated by multiple vets, so he was fully supportive of a trial. 

When it came to the vote ...

Guessing at which way the people who spoke might have voted, it seemed as though there were probably enough councillors with sufficient reservations about the motion, which would have given the go ahead for the trial, for it to be voted down.

That said, the overall sentiment in the room seemed to be that the discussion about the regulation of telemedicine and remote prescription needs to continue, and not get kicked into the long grass simply because of a disagreement over the proposed trial. 

At this point, Jo Dyer and others stepped in to argue that the decision to proceed with the trial should not be made until the issues raised in the debate had been addressed. There was then a lot of going backwards and forwards, discussing whether this would need a new motion, which is not allowed under Council rules, or whether the existing motion could be amended, which is allowed.

In the end, the decision was taken to hold two votes, the first being to refer the issue back to the Standards Committee which was carried by 18 to 12, with one abstention. 

The second vote was:

"Council is invited to consider the recommendation of Standards Committee to prepare and develop a proposal for a time-bound and limited trial to assess the benefits and risks of allowing the remote prescription of POM-V with appropriate stakeholder engagement and with consideration of the issues that we've discussed today and the detail on them, including 24/7 care and classes of drugs, especially antimicrobials. So we are asking for the detail on that to be worked up on the basis that it will at some time come back to Council."

The second vote was carried by 21 to 8 with 3 abstentions. 

In other words, the trial will not now go ahead unless Standards can develop a new proposal which addresses the concerns raised by Council.

VetSurgeon Conclusion

Looked at solely in terms of its impact on animal welfare, this debate seems to come down to one question, which is whether more animals will benefit from easier, cheaper access to veterinary services available via telemedicine and remote prescription than will suffer as a result of misdiagnoses and missed diagnoses that will surely be the inevitable consequence of veterinary surgeons working only from the more limited, and potentially inaccurate or even false information they will get from a video consultation.

For sure, more wearables are coming, and they will overcome some of the problems caused by the fact that animal patients cannot describe their symptoms. Doubtless someone will also invent a set of weighing scales that makes it possible for owners to do the job reliably accurately. Patient histories will surely become more portable. But these things are not with us just yet. 

In any event, it is not just about the immediate impact on the quality of care delivered to patients. The way the trial has been framed thus far takes us in the direction of a two-tier profession. What happens if more veterinary surgeons prefer, or make a better living from working from the comfort of their own home without the added responsibility that comes with providing the physical care. Who’ll do the ‘real' vetting?

If you look at the popularity of human telemedicine, the 30,000 patients who have signed up for telemedicine at the small practice in the Lillie Road in London, it seems obvious that patients want the convenience of consulting online, without having to schlep to the practice and find a parking space. It also seems self evident that if online consultations are offered at a lower price point, it will inevitably lead to more pet owners availing themselves of veterinary advice, though as Lynn Hill said, it’s unlikely to cause a mad rush whilst Dr Google is still free. 

Perhaps, though, there is another valid way to solve this conundrum. Rather than rushing headlong into a trial that could irrevocably change the very nature of the profession, how about establishing some pragmatic ground rules from the outset. For example, that unless by unanimous agreement of Council in the future, telemedicine should only be allowed as an extension of the service offered by existing bricks and mortar practices to their existing clients. 

When it comes to remote prescribing, surely the safest way to regulate it (if you’re going to allow it at all) is to do so on a drug-by-drug basis. Perhaps trial it with the endo- and ecto-parasticides for existing clients of existing practices. Find out whether the convenience of the online consultation leads to higher standards of parasite control for greater numbers of pets. If it doesn’t, then ditch it. Either way, it doesn't preclude trying another category of drug.

That’s my tuppence worth, for what it’s worth, which probably isn’t quite tuppence!