The RCVS Disciplinary Committee has suspended two veterinary surgeons from the Register after finding them guilty of lying to clients and the College about the circumstances of a castration procedure which led to the death of a dog.

The Committee suspended Mr Mpho Donald Lesolle and Mr Georgi Cheshmedzhiev from the Register for four and two months respectively, following surgery undertaken on Benson, a two-year-old male Labradoodle belonging to Mr and Mrs Grayson.

During the proceedings, the Committee heard that, on 6 August 2013, Mr and Mrs Grayson brought Benson to the Swinfen Veterinary Centre in Stafford, where Mr Lesolle is the practice principal and Mr Cheshmedzhiev was his assistant, for the operation which was undertaken by Mr Cheshmedzhiev. Mr Lesolle did not directly supervise the procedure telling the Committee that he was confident that his colleague could carry out the castration, having permitted him to do so on previous occasions.

The Committee heard that, after the operation, a nursing assistant, Ms Bell, had noticed that there was blood on the bedding and that Benson had a swollen scrotum. Mr Lesolle then performed a scrotal ablation on Benson, who was discharged later that day.

However, on the morning of 8 August 2013, Mrs Grayson discovered that Benson had died during the night. An independent post-mortem concluded that he had probably died of intra-abdominal bleeding which caused circulatory collapse. Mr and Mrs Grayson raised a concern with the RCVS in September 2013.

The charge against Mr Lesolle relates to his actions following the operations and during the investigation. The four parts of the charge were that he failed to be sufficiently open with Mr and Mrs Grayson on the circumstances of Benson’s surgery; that, in September 2013, he wrote to the College indicating that he had in fact performed the castration and failing to state that there had been two operations; that, on 23 January 2014, he informed Pam Mosedale, a Veterinary Investigator employed by the College, that he had carried out both procedures; and that, on the same day, he also encouraged his veterinary nursing assistant Ms Bell to be dishonest with the College’s investigators. 

Mr Lesolle, who was present at the hearing, admitted all parts of the charge against him. He told the Committee that he decided to take responsibility for Mr Cheshmedzhiev’s operation out of a desire to protect his colleague whom he regarded as vulnerable and lacking in self-confidence. He also accepted that he had encouraged Ms Bell to lie during her interview. He told the Committee that he had persisted with the deceit until 15 January 2015, when he gave a full account of what had occurred.

The three parts of the charge against Mr Cheshmedzhiev, who was not in attendance or represented at the hearing, were that in a letter to the College sent in September 2013, he indicated that he had not undertaken the castration procedure on Benson; that on 23 January 2014 he had denied carrying out the operation while being interviewed by Pam Mosedale; and that, on 19 June 2014, while being interviewed by a solicitor instructed by the College, he said that Mr Lesolle had carried out both procedures.

The Committee found the charge against Mr Lesolle amounted to serious professional misconduct, falling far short of what is expected of a professional. The Committee highlighted the protracted nature of his deceit and the fact that he encouraged another member of staff to participate in it. However, it did accept that his motivation was to protect Mr Cheshmedzhiev.

In deciding on the sanction for Mr Lesolle, the Committee considered the aggravating and mitigating factors. Ian Green, chairing the Committee and speaking on its behalf, said: “Having taken the calculated decision to deceive the College as to what had occurred, he abused his position of responsibility to obtain support for his deceit by involving a junior employee, without any proper consideration of the effect of that decision upon her. Instead he continued with the deceit until he was presented with incontrovertible evidence that he had not carried out both procedures on the dog. In the Committee’s view he showed a wilful disregard for the College’s investigatory process.”

However, in mitigation, it also accepted that he was protecting a colleague and that there was no financial gain. It also considered his personal circumstances, the fact that he is sole principal of a small mixed practice which provides his sole source of income and that the rented accommodation also provides a home for his wife and two children. Taking all factors into account, the Committee imposed a sanction upon Mr Lesolle of four months’ suspension from the Register.

In regards to Mr Cheshmedzhiev, the Committee did not find the part of his charge relating to the letter sent in September 2013 to be proven but, in respect of the other two parts of his charge, found that his conduct fell far short of what is expected of a professional. It highlighted his willing participation in the deceit over a protracted period and his failure to take responsibility for his own involvement in the operation on Benson. 

In deciding the sanction, the Committee said that the fact that Mr Cheshmedzhiev had lied to the College’s investigators on two occasions and did not admit that he had carried out the castration and apologise for his actions until February 2015, after he had returned to his native Bulgaria, was an aggravating factor.

Ian Green added: “The Committee accepts that he allowed himself to be persuaded by Mr Lesolle to provide a dishonest account of what had taken place to the College’s investigator Mrs Mosedale, and solicitor, Mr Hudson. It also accepts that he has been described by Mr Lesolle as a vulnerable person, lacking in self-confidence in his ability to practise as a veterinary surgeon in the United Kingdom.

“Nevertheless, Mr Cheshmedzhiev accepted the obligations contained in the Code of Professional Conduct when he registered as an MRCVS, which included an obligation to cooperate honestly with the College’s investigatory process. It has also noted that he has expressed a present intention not to work in or visit the United Kingdom again.”

Taking into account all factors, the Committee decided the appropriate sanction was to suspend him from the Register for two months. 

The RCVS DC has directed that a Wirral-based veterinary surgeon should be removed from the Register after finding that he had treated clients badly, kept inadequate clinical records, was dishonest in dealing with the RCVS, and that animals in his care were placed at risk.

At the end of the five-day hearing, the Committee found that Ian Beveridge, of the Daryl Veterinary Centre, Heswall, was guilty of charges relating to two separate cases: one concerning a crossbred bitch named Holly, who belonged to Mr and Mrs Flanagan and was treated in February 2011; and the other, a cat called Blu, belonging to Ms Simpson and treated in March 2010.

On the morning of 23 February 2011, Holly was admitted to the Daryl Veterinary Centre in a collapsed state with a swollen abdomen. The Committee found a proper assessment should have led Mr Beveridge to perform an abdominocentesis at the practice, the results of which, in view of the practice and its facilities, would inevitably have led to Holly immediately being referred elsewhere. However, the Committee heard that Mr Beveridge simply placed her on a heat pad for observation until about midday, something it considered no reasonably competent veterinary surgeon in general practice would have done. The Committee also found that, on more than one occasion, Mr Beveridge had refused to discuss referral with Mrs Flanagan, and this amounted to failing to treat her with courtesy and respect as required by the RCVS Guide to Professional Conduct 2010, which applied at that time. Holly was ultimately referred elsewhere and survived. The Committee also found the records of Holly's admission to be completely inadequate.

Blu was presented on 22 March 2010 in a collapsed state by Mr Taylor, Ms Simpson's former partner with whom the cat lived. The Committee found that Mr Taylor was told that the cat would be kept on a heat pad, that no other treatment or diagnosis was discussed, and that the possibility of euthanasia was not raised. Having been unable to contact Mr Beveridge that evening, Ms Simpson went to the practice the following morning, intending that her cat be discharged and taken elsewhere. However, the Committee found, when Mr Beveridge eventually fetched Blu, who had died, he blocked Mrs Simpson's exit from the consulting room, saying words to the effect that had she been a better owner, none of this would have happened.

Mr Beveridge also sent to the College clinical records for Blu detailing a blood sample taken at 19.00 on 22 March, and subcutaneous fluids administered during that night. The Committee found this to contain deliberately false information in order to cast a better light on his management of Blu and that he was dishonest; the document was essentially a fabrication to enhance his own interests.

In reaching its decision, the Committee said that it made allowances for the fact that Mr Beveridge operated in first-opinion practice at a basic level. Notwithstanding this, however, it found him guilty of a very serious failure of care to both patients, which gave rise to serious risks to their safety and welfare.

Professor Peter Lees, chairing and speaking on behalf of the Committee said: "On each occasion [Mr Beveridge] treated the owners with a lack of courtesy and respect and made the difficult and distressing circumstances in which they found themselves much worse than they need have been. The Committee takes a very serious view of his attempt to prevent Ms Simpson leaving the consulting room with Blu, and of the unjust and upsetting way in which he sought to blame her for the animal's death. He showed her no consideration at all. Likewise his refusal to contemplate referral for Holly until compelled by Mrs Flanagan to do so and his persistent refusal to engage with her about this at all was, in the Committee's view, reprehensible."

The Committee directed Mr Beveridge's name should be removed from the Register.

The RCVS Disciplinary Committee has found Powys-based Stephen Kiernan Lomax MRCVS not unfit to practise after he was convicted of causing death by careless driving.

Mr Lomax was found guilty of causing death by careless driving at Shrewsbury Crown Court in July 2019 and was subsequently sentenced to a 12-month community order, 300 hours’ unpaid work, 15-months’ driving disqualification and ordered to pay £1,000 in prosecution costs and victim surcharge of £85.

Mr Lomax declared his conviction to the RCVS in April 2020 as part of his declaration upon renewing his registration, following which the RCVS started its concerns investigation process leading to his appearance before the Disciplinary Committee last Monday.

At the outset of the hearing Mr Lomax admitted the charge against him, which was also accepted by the Committee based on its receipt of the certificate of conviction from Shrewsbury Crown Court.

The Committee then considered whether the conviction rendered Mr Lomax unfit to practise. The RCVS submitted that the nature of the conviction and the devastating consequences of Mr Lomax's conduct, which caused the death of a 64-year-old woman, rendered him unfit to practise. 

The College also submitted that his conduct would be considered to have fallen far short of the standard expected of a member of the profession, that it had devastating consequences, and that the conviction would have an impact on the reputation of the profession and the public’s confidence in it.

Mr Lomax’s counsel, who represented him during the hearing, submitted that he did not accept his conduct rendered him unfit to practise as a veterinary surgeon, although Mr Lomax did accept that the impact of his conduct was devastating.

Mr Lomax’s counsel submitted that there was a significant difference between his conduct and its consequences, as evidenced by the fact he was charged with careless driving rather than dangerous driving meaning that, though his standard of driving had fallen below that expected of a competent and careful driver, it did not fall far below. Nor was there a suggestion that Mr Lomax had carried out a deliberate act, was carrying out any dangerous manoeuvres or was otherwise impaired.

Dr Martin Whiting, chairing the Committee and speaking on its behalf, said: “There is no doubt that the consequences of Mr Lomax’s conduct were serious and tragic for the [victim’s] family.

"The Judge at the Crown Court referred to their loss in detail and it no doubt played a significant part in the sentence he passed, as reflected by his comments.

"The Committee was cognisant, however, of the different role it had to perform.

"A criminal conviction marks a breach of criminal law, whereas a finding of unfitness marks a breach of professional standards.

"When looking at the conviction, the Committee focused on the actual conduct of Mr Lomax and the concomitant level of culpability, rather than the consequences. Whilst it would be artificial, insensitive and inappropriate to ignore the consequences, the Committee was concerned with the conduct.”

He added: “The Committee did not consider that Mr Lomax’s conduct was liable to have a seriously detrimental effect on the reputation of the profession and concluded that the public, in full knowledge of the circumstances of this particular case, would not expect a finding that the conviction renders him unfit to practise as a veterinary surgeon.

"Rather, the public would recognise that whilst the consequences were appalling for the [victim’s] family, in terms of Mr Lomax’s culpability this was a momentary piece of poor driving rather than anything more blameworthy. At its height it was careless driving for three or so seconds.

"In the Committee’s view Mr Lomax’s careless behaviour fell below, but not far below, the standard expected of a veterinary surgeon and did not amount to disgraceful conduct in a professional respect.”

 The full findings of the Disciplinary Committee can be found at www.rcvs.org.uk/disciplinary

Stephen Prichard has been struck off by the RCVS Disciplinary Committee after he was found to have taken and used controlled drugs, reported for work while unfit to do so, and ignored requests from the College to respond to the concerns raised against him.

The hearing took place in Mr Prichard's absence after he failed to respond to Colleges attempts to contact him, including by email, post, telephone and personal service of documents.

However, in its decision to proceed in Mr Prichard’s absence, the Committee confirmed that it would not hold his non-attendance against him or attach any adverse inference to that fact.

Mr Prichard was charged with taking quantities of the controlled, prescription-only drug Vetergesic from the practice’s stock other than for legitimate veterinary use. 

He was further charged that he took Vetergesic from the practice by drawing it into a syringe for the purposes of self administration, and that in doing so, his conduct was dishonest.

In another set of charges, it was alleged that on five separate occasions, Mr Prichard had attended the practice to work as a veterinary surgeon whilst unfit to do so.

The final charge related to Mr Prichard’s failure to respond adequately or at all to all reasonable requests from the RCVS for his response to concerns raised about his conduct.

At the beginning of the hearing Nicole Curtis, acting on behalf of the College, read the written evidence from 11 separate witnesses outlining the facts related to the charges against Mr Prichard, including the record of an investigative meeting held by the practice in which he admitted his theft and use of the controlled drug and following which, he was dismissed from his employment.

The Committee found all the charges proven and then considered whether they amounted to serious professional misconduct.

In terms of aggravating factors the Committee found that there was a risk of injury, recklessness, premeditated and sustained misconduct, and that there was an abuse of his professional position in accessing prescription-only controlled drugs for reasons other than legitimate veterinary use.

In mitigation, the Committee considered that he had made admissions as part of the practice’s internal disciplinary investigation.

Overall, the Committee found he had breached aspects of the Code of Professional Conduct related to honesty and integrity, making animal health and welfare his first priority, appropriate use of veterinary medicines, taking steps to address physical and mental health conditions that could affect fitness to practise, responding to reasonable requests from the RCVS, and bringing the profession into disrepute.

Therefore, the Committee found him guilty of serious professional misconduct in relation to all of the charges charges.

The Committee felt that, considering the seriousness of the misconduct, removal from the Register was the most appropriate decision.

Austin Kirwan, chairing the Committee and speaking on its behalf, said: “This is a case involving serious dishonesty, sustained over a period of time, and conduct potentially detrimental to animal welfare, as well as wilful disregard of professional regulations.

“Regrettably, Mr Prichard’s failure to engage with the College and with the regulatory process limited the options open to the Committee.

"Notwithstanding this, Mr Prichard’s disgraceful conduct is so serious that removal from the Register is the only means of protecting animals and the wider public interest which includes the maintenance of public confidence in the profession and the upholding of standards.”

www.rcvs.org.uk/disciplinary

ITV's Tonight programme broadcast last night portrayed a veterinary profession in which overcharging is commonplace.

Researchers for the programme took three healthy animals (a cat, a dog and a rabbit) to a number of different vets, telling them that the animals were off their food. The advice they were given varied. In the case of the rabbit from no treatment necessary, to dental work under general anaesthetic.

TV vet Marc Abraham then looked at each animal and told viewers that the correct advice in each case would have been the least expensive.

The programme also highlighted the substantial savings that pet owners can make by buying drugs online, and questioned whether the penalty meted out to a vet that had committed malpractice was sufficient (the vet had been struck off for 14 months, where presenter Jonathan Maitland argued it should have been for life).

Veterinary business consultant Mark Moran said: "So often, vets rely to a large degree on what owners are telling them, and the degree to which they insist the animal is ill, or off its food, will affect the advice and treatment given. Marc Abraham had the luxury of being presented three animals that he knew to be perfectly fit and well."

However he agreed wholeheartedly with the response from RCVS President Jill Nute this morning, that the thing both vets and pet owners need to learn from the programme is "the importance of communicating with each other".

Mark said: "It's a question of managing people's expectations. There'll always be a variance in the advice being given, but being up-front and open will help mitigate the risk of being accused of overcharging".

Click here to watch the programme.
Click here to read the reactions to Marc Abrahams' blog

The RCVS Education Committee and Primary Qualifications Subcommittee have announced that there will be a new format for the Statutory Membership Examination from 2019.

The Statutory Membership Examination must be taken by all individuals educated outside of the UK whose veterinary qualification is not recognised by the RCVS. Passing the exam allows them to join the UK Register, and practice as a veterinary surgeon in the UK.

The exam has existed in its current format for over 30 years, and the review was implemented to ensure the examination remains fit for purpose, and sits in line with international best-practice and the College’s current Day-one Competences.

The College says the review was also designed to make sure it is using the most appropriate means of assessment methods, to best prepare candidates for success, and to ensure candidates can work in the UK to the best of their ability. 

The written examination will now consist of two parts; a clinical Multiple Choice Question (MCQ) paper (in a single best answer clinical vignette format) and an open book examination, which will be used to ascertain the candidate’s knowledge of the RCVS Code of Professional Conduct.

The Clinical, Practical Examination will now exist in the form of a multi-dimensional Objective Structured Clinical Examination (OSCE). This examination is set to measure a range of clinical, technical and professional skills including clinical reasoning, communication, professionalism, and ethical awareness. Following a tender process, Glasgow Veterinary School has been awarded the contract to host the OSCE examination for five years from 2019 to 2023. 

RCVS Examinations Manager, Victoria Hedges, said: "The review of the Statutory Membership Examination has provided us with the opportunity to ensure that we continue to test the skills and knowledge needed to work effectively in a veterinary practice in the UK in a robust manner, and bring it in line with the final year examinations delivered at UK vet schools. In designing the examination, the RCVS has considered international best practice, in addition to approaches to regulatory examinations within both the veterinary and medical sectors."

A comprehensive handbook regarding this new examination will be available on the Statutory Membership Examination section of the RCVS website (www.rcvs.org.uk/statutory-membership-exam) shortly.

If you have any questions, please get in contact with Examinations Manager, Victoria Hedges: v.hedges@rcvs.org.uk

Vet Futures, the joint initiative by the RCVS and the BVA to help the profession prepare for and shape its own future, has published a guest blog in which an academic argues that the profession needs to introduce safeguards to prevent inappropriate profit-seeking behaviour.

David Main is Professor of Animal Welfare at the School of Veterinary Sciences at the University of Bristol, with research interests in welfare assessment, animal welfare education and intervention strategies to improve welfare.

In his blog (www.vetfutures.org.uk/discuss), Professor Main says he believes the vast majority of individual veterinary surgeons and practices are not motivated by money and do have animals’ best interests at heart, but that the differences between the business structure of veterinary and medical practitioners in the UK means the profession is always at risk of standing accused of excessive profiteering. 

He said: “Since we still live in the age of the media scare story, it would seem prudent for the profession to embed some anti-profit seeking safeguards in our regulatory controls before, rather than after, a problem is highlighted.” One suggestion he makes is for the prohibition of turnover-based incentive schemes in favour of incentives based on health outcomes. 

He believes that such safeguards, which he says could be incorporated into the RCVS Practice Standards Scheme, would be a “healthy demonstration” that the profession has animal welfare rather than profit as its main priority.

Professor Main also argues that the profession urgently needs to deliver on society’s expectation of vets as animal welfare experts: “Veterinarians could perhaps... do more at an individual level to act as animal welfare advocates. It is easy to inform clients on the technical rationale for a specific husbandry change but then walk away knowing full well the client will not action the advice. In the medical profession, advanced communication techniques are becoming more widely accepted to promote positive change within their patients. Perhaps we should be more explicit in teaching our veterinary students influencing skills.”

In response to David’s blog, this month’s Vet Futures poll asks visitors ‘Do vets always act as animal welfare advocates?’

The previous month’s poll, which was based on an article co-written by Erwin Hohn and Adi Nell from MediVet, asked to what extent vets would be willing to work collaboratively with others if it would benefit all. Of the 50 people who answered the poll, 60% said they would be completely willing to work with others, 32% a lot and 8% to some degree – no one said they would be unwilling to work with others.

The RCVS has confirmed that it commissioned an independent investigation earlier this year which has failed to discover who leaked information contained in confidential Council papers. 

The College first became aware that confidential information had been leaked earlier this year after the Veterinary Record made the decision to publish details. 

The College says it then provided a number of informal opportunities for the person leaking the information to come forward and discuss the reasons for their actions, but nobody stepped forward.

A Council member then made a formal complaint about the leak, which triggered the complaints policy set out in the College’s Code of Conduct for Council Members and instigated the investigation.

The investigation was run independently of the RCVS by an external specialist consultancy, and coordinated by a legal assessor.

Initially, the investigators were asked to focus on a single leak, but following a number of further leaks over ensuing months, it became necessary to widen the scope and depth of the investigation.

The investigators’ report concluded that there had been several separate and deliberate leaks of confidential information by a current or former Council member over an extended period.

However, they were not able to identify who specifically was responsible for the leaks, and because nobody admitted it, no further action under the complaints policy of the Code of Conduct for Council Members was appropriate.

The investigators concluded that the leaks were not the result of poor understanding of College or Council processes, but a deliberate decision to provide confidential information to third parties.

Council members have therefore agreed to review existing training requirements and mechanisms for handling confidential information and to explore in more detail the potential motivation of the person or people who leaked the information, together with the underlying culture of Council that might have influenced their behaviour.

RCVS President Mandisa Greene, said: “There is no denying this is a sad day for the College, and for RCVS Council in particular. As Council members of our professions’ regulatory body, we must maintain the very highest standards of probity and integrity if we are to maintain the trust and confidence of our professional colleagues. In the same way, we must subject ourselves to the same level of scrutiny and investigation if these values and behaviours are ever called into question.

“That someone chose to breach the trust placed in them by their peers is extremely disappointing, especially when they were given every opportunity to come forward to discuss their concerns, and avoid the College having to launch a formal investigation.

"Our default position during Council meetings is to hold as many discussions as possible in public session to ensure Council’s decisions are as open and transparent as possible – something that we will continue to increase as much as possible. Like any organisation, however, there may be a small number of issues that need to be discussed in closed session – for example, those still at concept stage prior to any decision being made public or put out for consultation, or those containing personal or commercially sensitive data.

"I sincerely hope that all of us on Council can learn from this unfortunate and unnecessary episode. We must rebuild and maintain sufficient confidence in each other, and in our processes, that, even if we disagree on certain matters, it is always best to do so in a direct, upfront and honest manner."

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!

The RCVS has updated its supporting guidance for veterinary surgeons and veterinary nurses on informed consent, with more advice on discussing informed consent with clients and who is responsible for seeking consent.

The Codes of Professional Conduct for both veterinary surgeons and veterinary nurses stress the need for effective communication with clients and ensuring that informed consent is obtained and documented before treatments or procedures are carried out.

At its January meeting RCVS Standards Committee approved changes to chapter 11 (‘Communication and consent’) of the supporting guidance to the Codes to provide further advice to the professions on matters that should be discussed with clients to ensure informed consent is gained, provide clarification on who can gain consent for a procedure and give some additional guidance on consent forms.

Nick Oldham, Standards and Advisory Manager at the RCVS, said: "We hope that this updated guidance is more accessible, readable and will aid members of the profession in developing a more comprehensive approach to gaining informed consent for treatments and procedures and therefore reduce the risk of miscommunication and misunderstanding which can lead to concerns being raised by clients. 

"For example, we have updated our guidance to encourage veterinary surgeons to consider discussing a number of additional factors with a client before obtaining consent. This includes the nature, purpose and benefits of any treatment or procedures, the likely outcomes including potential risks, financial estimates, informing the client when other treatments may have available and checking that the client understands what they are agreeing to rather than assuming the client understands both the potential financial outlay and possible side effects.

"Furthermore, there is now additional guidance for veterinary surgeons on who should be seeking consent. While ordinarily it is expected that the veterinary surgeon undertaking the procedure or providing treatment is responsible for obtaining the client’s consent we know that this is not always practical.

"Therefore we clarify that the responsibility of obtaining consent can be delegated to another veterinary surgeon and, failing that, a registered veterinary nurse or student veterinary nurse could obtain consent provided that they are suitably trained, have sufficient knowledge of the proposed procedure or treatment and understand the risks involved.

"The RCVS Standards and Advice Team is also in the process of producing a series of fictional case studies based on informed consent issues encountered by the College’s Preliminary Investigation Committee which we hope will further help the profession."

The updated supporting guidance can be found in full at www.rcvs.org.uk/consent

The Code of Professional Conduct and its supporting guidance can also be downloaded as an app for smartphones and tablets at www.rcvs.org.uk/codeapp

Members of the profession seeking confidential advice on matters relating to professional conduct can contact the Standards and Advice Team on 020 7202 0789 or advice@rcvs.org.uk

The RCVS Disciplinary Committee has reprimanded Lincolnshire-based Elizabeth Sing May Law MRCVS after hearing charges against her and Julia Louise Creese MRCVS which concerned an incident where a dog remained at their practice overnight without adequate monitoring and/or post-operative aftercare.

The charge against Ms Law was that in November 2017, having performed surgery on Kiwi, a German Shepherd/Wolfhound-cross dog, to address gastric dilation volvulus (GDV), she failed to obtain informed consent to the entirety of the surgical process and management, including post-operative aftercare.

The charge also stated that she failed to provide adequate analgesia to Kiwi before, during or after the surgery, failed to provide appropriate and adequate fluid therapy to Kiwi, failed to offer an appropriate and adequate post-operative care plan and/or post-operative transfer for Kiwi to another practice and failed to inform the owners that there would be nobody present at the practice to provide post-operative monitoring and aftercare for Kiwi for approximately seven hours during the night.

Finally the charge stated that Ms Law allowed Kiwi to remain at the practice overnight from 12:30am to 07:45am without adequate monitoring or post-operative aftercare.

Ms Law admitted some of the charges against her, including that she had failed to obtain informed consent, failed to offer an appropriate and/or adequate post-operative care plan, failed to inform the owners that there would be nobody present at the practice and allowed Kiwi to remain at the practice overnight without adequate monitoring and/or post-operative aftercare. However, she denied that she failed to provide adequate analgesia or fluid therapy to Kiwi. 

The Committee found all of the charges proved, with the exception of failing to provide adequate analgesia during the perioperative period.

Having considered the facts, the Committee then moved on to consider whether the admitted and proven charges against Ms Law amounted to serious professional misconduct, taking into account any aggravating and mitigating factors. The aggravating features were that, as a result of Ms Law’s failures in relation to analgesia and fluid therapy, there was either actual injury to Kiwi, or a risk of such injury.

In mitigation, the Committee considered that she promptly and accurately diagnosed GDV, and proceeded to perform the necessary emergency surgery. The Committee considered that the charges related to a single isolated incident and that Ms Law has had an unblemished career to date. They also noted that Ms Law had made open and frank admissions as to the majority of the charges. 

The Committee found that the conduct of Ms Law set out in the majority of the charges did not amount to serious professional misconduct. However, in the judgement of the Committee, Ms Law’s conduct in allowing Kiwi to remain at the practice overnight without adequate monitoring or post-operative aftercare did amount to serious professional misconduct. 

Jane Downes, who chaired the Committee and spoke on its behalf, said: "The Committee considers that the respondent (Ms Law) has insight into the serious mistake that she made in failing to ensure that Kiwi was checked or monitored overnight. The Committee has found that this was a single isolated incident, which involved a serious lapse of clinical judgement, which will probably stay in the mind of the respondent for the rest of her career.

"The respondent has been in practice for some nine years now, and apart from this incident, there is no suggestion that the respondent has fallen short of the standards expected of her on any other occasion.  The Committee does not consider that there is a risk that the respondent is likely to leave an animal overnight after major surgery again, without ensuring that it is checked during that time, and, as such, the Committee considers that there is no future risk to the welfare of animals so far as the respondent is concerned."

The Committee considered that the finding of disgraceful conduct in a professional respect in this case is too serious for no further action to be taken, having regard to the need to maintain public confidence in the profession and declare and uphold proper standards of conduct.

The Committee therefore concluded that the appropriate sanction in this case was to issue a reprimand to Ms Law, in relation to the finding of serious professional misconduct.

Jane Downes added: "The Committee considers that this sanction, coupled with the findings of fact and disgraceful conduct made against the respondent, is sufficient to maintain public confidence in the profession and uphold proper standards of conduct. The Committee does not consider it necessary to issue a warning to the respondent about her future conduct, on the basis that the Committee has concluded that there is no risk of repetition."

There were three charges against Ms Creese, all pertaining to the period between July 2016 and November 2017.

The first charge was that she failed to ensure that there were adequate systems and processes in place for out-of-hours’ care for in-patients.

The second charge was that she publicised that the practice had "24 hour care provided by our vets at our practice" and/or "Care 24/7 for your pets" on its website, which suggested that staff were present at the practice 24 hours a day when they were not and as such publicity was dishonest and/or misleading.

The third charge against Ms Creese was that she failed to ensure that Kiwi's owners were informed about arrangements at the practice for out-of-hours’ care for in-patients. 

At the outset of the hearing, Ms Creese denied all the charges against her. 

After hearing evidence from relevant witnesses, the Committee considered that the practice did have in place systems and processes for out-of-hours care for in-patients and that there was no evidence of repeated or ignored failures of these systems and processes. The Committee therefore found the charges against Ms Creese not proved and all three were dismissed.

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

Northamptonshire-based Gabor Nemes MRCVS has been found not guilty of serious professional misconduct, after posting derogatory remarks about his employer, Mate Toth MRCVS, on Facebook.

The RCVS Disciplinary Committee heard two charges against Dr Nemes, the first being that he had posted comments on social media about another veterinary surgeon, his employer, Dr Toth, which were offensive and/or derogatory and/or inappropriate.

The second charge was that Dr Nemes had posted his comments without having sufficient regard to maintaining their confidentiality and/or privacy. 

Dr Nemes admitted the charges, though he did inform the Committee that his admission with respect to the second charge was caveated by the proposition that the comments were posted in private messages on Facebook with a limited membership, namely employees of Healers Veterinary Centre (Dr Toth’s practice).

The Committee noted the Respondent’s admissions as to the charges raised against him and pronounced the facts found proved.

In relation to the first charge, the Committee found that the comments on social media were, without a doubt, highly unprofessional. They included offensive language, were gratuitously personal against Dr Toth, and were made within an online chat which included junior lay staff, all employed by Dr Toth.

This behaviour was seen to directly contravene a numbers of parts of the RCVS Code of Professional Conduct, in particular Paragraph 5.3 that states: "Veterinary Surgeons and Veterinary Nurses should not speak or write disparagingly about another Veterinary Surgeon or Veterinary Nurse."

In relation to the second charge, the Committee found that Dr Nemes had paid no regard to maintaining the confidentiality and/or privacy of his malicious and damaging entries to the chat. 

At the outset of his evidence, Dr Nemes admitted that the proven charges amounted to serious professional misconduct. The Committee noted however that the question of whether he was guilty of serious professional misconduct or not was in fact a matter for it to decide, notwithstanding his admission.

The Committee considered the fact that the period of time that Dr Nemes was involved in making postings was effectively about two weeks, that his involvement followed his wife’s dismissal from employment (representing a breach of Dr Nemes’ resignation conditions), and that he was very stressed at the time.

It also considered Dr Nemes’ point that he had never anticipated that Dr Toth would see the Facebook Messenger conversation, and that the relevant RCVS supporting guidance to the Code concerning good practice when using social media and online networking forums was only published in late November 2014 when Dr Nemes’ involvement in the conversation was virtually at an end.

In summing up, Ian Green, Chair of the Committee, said: "The Committee carefully considered the circumstances surrounding the Facebook Messenger entries which the Respondent posted from 13 November 2014. It noted that at the time he had handed in his resignation, morale at the practice was very low. The Facebook Messenger chat site had been started amongst the receptionist/animal carers. A perusal of the entries before the Respondent joined on 13 November 2014 demonstrates that morale was low among that group.

"…Notwithstanding the nature of the remarks posted on the Facebook Messenger, which the Committee deplores, it has reached the conclusion that, whilst the Respondent’s behaviour amounts to misconduct and falls short of the standards expected of a member of the veterinary profession, it does not amount to serious misconduct and does not fall far short.

"In the circumstances it has reached the unusual conclusion that, notwithstanding the Respondent’s admission, the appropriate finding is that he is not guilty of disgraceful conduct in a professional respect."