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 published a series of case studies designed to help veterinary surgeons and veterinary nurses in gaining properly informed consent from clients for procedures and treatments.

The case studies were developed by the RCVS Standards Committee and use a variety of examples of where miscommunication between a client and the veterinary practice can lead to an inadequate level of consent being gained for procedures and treatment, including euthanasia.

Examples include damaged teeth being removed during a clean and polish dental procedure without the owner’s express permission and not giving the full range of options available in the case of a dog with an osteosarcoma.

The case studies follow the Standards Committee approving changes to chapter 11 (‘Communication and consent’) of the supporting guidance to the RCVS Code of Professional Conduct in January 2018 to give further advice on how to discuss informed consent with clients, who can be responsible for gaining consent for a procedure and additional guidance on consent forms.

Dr Kate Richards MRCVS, Chair of the RCVS Standards Committee, said: "We hope these case studies will prove useful to practitioners who are having to deal with the complexities around making sure that procedures are fully explained to ensure informed consent is gained.

"We understand the difficulties that are encountered and so these case studies, based on real-life scenarios, highlight where things may go wrong and how these incidents can be avoided by being thorough and ensuring that good communication is at the heart of all we do."

To view the case studies, visit www.rcvs.org.uk/informed-consent.

Chapter 11 of the RCVS supporting guidance on communication and consent is available to view at www.rcvs.org.uk/consent

The RCVS is calling on everyone to nominate veterinary surgeons, veterinary nurses and laypeople who are working above-and-beyond for the benefit of animal health and welfare, the veterinary professions or public health, for one of its 2019 honours and awards.

This year the College is seeking nominations for six awards:

• The Queen’s Medal: the highest honour that can be bestowed upon a veterinary surgeon for a highly distinguished career with sustained and outstanding achievements throughout.

• The Veterinary Nursing Golden Jubilee Award: this award is aimed at veterinary nurses who have had a sustained and distinguished career, who can demonstrate a leadership role within the profession and who can act as an ambassador for the value of veterinary nurses and their work.

• RCVS International Award: this award is for vets, vet nurses or laypeople who work internationally, from either within or outside the UK, in making an outstanding contribution to, for example, raising veterinary standards, veterinary education and improving animal health and welfare.

• RCVS Impact Award: this award is for vets or vet nurses who have recently, or are currently, undertaking a project, initiative or similar that has a significant impact on the profession at large, animal health or welfare, or public health. Such impact could have been made through any field of veterinary endeavour, including clinical practice, research, education or veterinary politics.

• RCVS Inspiration Award: this award is for vets or vet nurses at any stage of their career who have demonstrated the ability to inspire and enthuse others consistently throughout. It is open to those who have inspired and motivated individuals anywhere within the profession and recognises those who have gone ‘above and beyond’ what may normally be expected from a professional colleague.

• Honorary Associateship: this honour is conferred to a small number of laypeople each year, in recognition of their special contribution to the veterinary sphere. It recognises the full range of individuals who contribute to the veterinary sphere including scientists, lecturers, journalists, charity-workers, farriers, farmers and those involved in the commercial field.

For this year’s honours and awards nomination period, the College has produced a video using footage from Royal College Day 2018, featuring interviews with those who were recognised with RCVS honours and awards on the day. 

The video is available to view at www.rcvs.org.uk/honours where you can also download further information and guidance about the criteria for nominators and nominees for the awards, as well as how to make nomination.

Dr Niall Connell, RCVS Junior Vice-President, is taking the lead in promoting the awards this year. He said: "Throughout my time in the veterinary profession, and particularly since joining RCVS Council, I have met so many veterinary nurses and veterinary surgeons who are truly inspiring individuals.

"The RCVS honours and awards scheme is a perfect opportunity to celebrate some of the individuals that have done or are doing something really special – whether that’s by inspiring their colleagues and peers or doing things that benefit animal health and welfare or society at large.

"Across all six awards there really is something for everyone – vets and veterinary nurses at all stages of their careers as well as laypeople are all up for recognition and so I’d strongly encourage everyone to think about someone they know who deserves recognition and get in touch.”

The deadline for nominations is Friday 18 January 2019. 

For an informal talk about the awards and how to make a nomination you can contact Peris Dean, Executive Secretary, on p.dean@rcvs.org.uk or 020 7202 0761.

The RCVS Disciplinary Committee has issued a reprimand and warning to Essex-based Donald Stuart Bremner MRCVS, following a conviction of harassment and perverting the course of justice.

Dr Bremner was convicted in 2017 of harassing his ex-wife, and for perverting the course of justice by sending his daughter an e-mail, pressuring her to ask her mother to withdraw the charges against him. He pleaded guilty to both of the charges, saying he did not understand that it was a condition of his bail that he could not contact his ex-wife. He also expressed shame and remorse at his actions, explaining that his behaviour was triggered by extreme anger, grief and stress.

In relation to the charges, the Respondent was committed to prison for 12 months, suspended for 12 months, ordered to comply with a Rehabilitation Activity Requirement within 12 months, and ordered to pay £85 in costs and £115 as a surcharge to pay for victim services.

The Committee found the facts proved based on the certified copy of the certificate of conviction, as well as the Respondent’s admissions to the facts of the charges. It was satisfied that the Respondent brought the profession into disrepute by the seriousness of his convictions. In addition, the Committee regarded the Respondent as having deficient insight and a need to fully accept personal responsibility for his actions and their consequences. 

The Committee was also satisfied that the nature of the communications sent by the Respondent which led to the convictions and the breach of bail conditions, coupled with deficient insight amounted to serious professional misconduct and rendered him unfit to practise veterinary surgery.

The Committee considered various mitigating factors including the fact that no actual harm occurred to any animal, there were no concerns raised about the respondent’s practice, that he has a long and unblemished career, and that he showed some insight into his offences which continues to develop.

The Committee also took into account that preventing the Respondent from practicing could mean the loss of jobs for 33 or so employees, which weighed heavily on their decision. The Committee also agreed with the RCVS’s submissions that there was a very low likelihood of repetition of the offending behaviour. Aggravating factors included the emotional harm caused to the Respondent’s ex-wife, and that the harassment was a course of conduct sustained over a period of five months.

Therefore, when taking into account the particulars of this case, the Committee decided to impose a reprimand and warning on the basis that it would be proportionate to maintain public confidence in the profession in light of the serious nature of these charges. 

Chitra Karve, chairing the Committee and speaking on its behalf, said: "The Committee was of the view that the conviction for intending to interfere with the course of justice was particularly serious, in light of the need to maintain public confidence in the profession, because it involved a disregard of proper criminal process.

"However, a particular feature of this case is the risk to the jobs of 33 or so employees if the Respondent were to be prevented from practising as a result of the Committee’s imposition of a sanction. It is this mitigating factor which weighed most heavily with the committee and they therefore concluded that both a Reprimand as to this conduct and a Warning as to any future conduct is sufficient and proportionate in this case to meet the need to maintain public confidence in the profession and uphold proper standards."

Mr Bremner has 28 days in which to make an appeal about the Committee’s decision to the Privy Council.

The RCVS Disciplinary Committee has found Cheshire-based Paul Stuart Thomason MRCVS not guilty of disgraceful conduct after hearing charges that he undertook a pre-purchase examination of a horse called Reba which caused him to have a potential or actual conflict of interest with the seller, about which he failed to inform the prospective buyer.

Dr Thomason initially denied both heads of charge, but on the third day of the hearing he changed his plea and admitted the charge in its entirety.

The first part of the charge related to the fact that the seller of the horse was a both a client of Dr Thomason’s practice and a personal friend of his, and he therefore had a potential and/or actual conflict of interest.

Dr Thomason did not disclose this professional and personal relationship to the prospective purchaser before the pre-purchase exam.

The prospective purchaser only discovered Dr Thomason’s relationship with the seller when reading the vetting certificate at home, and stated that, in the past, she had had a similar experience in which the horse was then found to be lame. She later found out the extent of the personal relationship, when invited to join the seller on a social media site.

The Committee found that, in this set of circumstances, Dr Thomason should not have undertaken the pre-purchase exam at all, and, at the very least, disclosed his personal and professional relationship with the vendor.

The Committee also found that although Dr Thomason did have a system in place to inform any prospective purchasers if the vendor was a client of his practice, this failed to work on this occasion and neither the practice nor Dr Thomason told the prospective buyer that the seller was a client before booking the pre-purchase exam. Dr Thomason had no similar system in place to disclose any close friendships with sellers.

Dr Thomason did not consider there was a conflict of interest as he felt confident he could carry out the pre-purchase exam impartially. In addition, it was his belief that the seller had been alerted to the conflict through a system in place at his practice, implemented to safeguard against this type of error. He stated that he in no way attempted to hide his relationship with the seller to the prospective purchaser. 

It was not alleged that Dr Thomason had acted dishonestly.

Ultimately, the Committee found Dr Thomason not guilty of disgraceful conduct in a professional respect.

Ian Green, chairing the Committee and speaking on its behalf, said: "Whilst the Committee concluded that the respondent’s view of his obligations to disclose both the professional and personal relationships he had with the vendor was mistaken, it did not find any improper motivation on his part. It has already noted that he sought to disclose to the prospective purchaser through his system the fact that the vendor was a professional client of his.

"The Committee has weighed all these matters very carefully. It is for the client to determine whether or not to proceed with a PPE when in possession of all relevant facts in relation to any potential conflict of interest, and not for the veterinary surgeon to decide. The autonomy of the client must be respected. The Committee was firmly of the opinion that a failure to comply with the Code is very serious. However, taking into account the particulars of this case, the Committee does not consider that the actions of the respondent amount to disgraceful conduct in a professional respect."

The RCVS Disciplinary Committee has directed the Registrar to remove Greater Manchester-based Viktor Molnar from the Register after he pleaded guilty to illegally importing puppies to the UK.

Mr Molnar had been convicted at Manchester and Salford Magistrates’ Court in March 2018 of five counts of importing puppies to the UK in contravention of the Rabies (Importation of Dogs, Cats and other Mammals) Order 1974.

At that court hearing he also pleaded guilty to one count of keeping premises as a pet shop without the authority of a licence granted by a local authority.

As a result of his conviction Mr Molnar was sentenced to 270 hours of unpaid supervised work and was ordered to pay compensation of £2,683.93 and costs of £250.

The Committee, which proceeded with the hearing in Mr Molnar’s absence, found that the RCVS charges against Mr Molnar were proven and went on to consider whether, individually and cumulatively, they resulted in Mr Molnar being unfit to practice being a veterinary surgeon.

Ian Green, chairing the Committee and speaking on its behalf, said: "The Committee accepts the College’s submission that the fact that they [the puppies] were imported contrary to the law of the UK, because they were underage and had not been properly vaccinated, undermines the integrity of a system which is designed to ensure that effective vaccination and precautions against disease take place in every case.

"The Committee also notes that the convictions in this case were directly linked to the respondent’s veterinary practice, as they related to animals sold from his veterinary practice address. By operating an unlicensed pet shop, and by doing so through an email address that referred to his occupation as a veterinary surgeon, the respondent was abusing his position as a veterinary surgeon, and acting in a way that was liable to undermine the reputation of the profession."

The Committee therefore found that, because Mr Molnar’s conviction was directly linked to his veterinary practice and posed a substantial risk to animal welfare and public health, his conviction meant his conduct fell far short of what was expected of a professional.

In considering the sanction for Mr Molnar the Committee considered that, while he had no previous convictions or adverse professional findings against him, the case against him was very serious "because of the risk of serious harm both to animals and the public, as well as being for financial gain."

Ian Green said: "The Committee considered that the respondent, as a veterinary surgeon, must have known the serious implications and consequences of what he was doing by importing these puppies unlawfully. The public should expect to be able to trust a veterinary surgeon to ensure that his conduct does not put at risk the health of both animals and humans."

Mr Green added that the Committee felt that the only appropriate sanction was to direct the Registrar to remove Mr Molnar’s name from the Register.

The Royal College of Veterinary Surgeons has been recognised as one of the best workplaces for women by the Great Place to Work Institute.

The College was ranked seventh in the medium-sized company or organisation category (50 to 449 employees) of the Best Workplaces for Women initiative. 

This year is the first that the Great Place to Work Institute has run this initiative and, in making its rankings, it looked at a number of factors including the number and proportion of women in leadership positions, pay parity between men and women, workplace policies and how they support female employees, as well as training and development and mentoring.

Amanda Boag, RCVS President, said: "I am delighted that the RCVS has been recognised for being an excellent and supportive place for women to work and pleased that the hard work of the team at Belgravia House in this area has been publicly rewarded in this way.

"One of the key themes of my Presidential year is diversity and I think it is very important that, as a regulator, we reflect the veterinary profession (which is currently 63% female for veterinary surgeons and 98% female for veterinary nurses) as far as possible. With two-thirds of the staff at the RCVS being women it demonstrates that the College is largely reflective of the profession it serves. 

"However, it’s not just about the numbers and with 60% of the Senior Team at the RCVS being women, including the CEO and Registrar, it demonstrates that the College has developed a culture in which women can shatter the glass ceiling and pursue leadership roles.

"Also, with policies such as flexible working hours, encouragement of home working, shared parental leave and enhanced maternity and paternity pay, the College goes the extra mile to support working parents."

Leeds-based Gary James Cassius Samuel has been struck off by the RCVS Disciplinary Committee following his conviction for animal welfare offences in 2016.

The Disciplinary Committee heard that Mr Samuel had been convicted of five animal welfare offences at Leeds Magistrates' Court in January 2016. The charges related to causing unnecessary suffering to a number of animals including twelve dogs and four cats, and failing to take steps to ensure that the needs of the animals for which he was responsible were met. The animals were kept at the Armley Veterinary Practice, for which Mr Samuel was, at the time, practice principal.

Mr Samuel was sentenced to 12 weeks' imprisonment suspended for 12 months on the condition he completed 150 hours' unpaid work and paid a fine of £100. He was also ordered to pay costs of £500 and a victim surcharge of £80. He was also made subject to a disqualification order for three years.

Dr Samuel subsequently appealed against his conviction in April 2018. His appeal was dismissed in respect of five of the charges but was upheld in respect of one charge, which, as a result, did not form part of the College’s case.

Dr Samuel declined to attend the hearing in person and was not represented before the Disciplinary Committee. In considering the facts of the charges against Dr Samuel the Committee found them proven.

The Committee then went on to consider whether the proven charges, both individually and cumulatively, rendered Dr Samuel unfit to practise as a veterinary surgeon.

The College’s case was that the convictions concerned animal welfare and therefore went to the heart of his practice as a vet, that Dr Samuel behaved in a manner incompatible with being a veterinary surgeon, that he failed in his core responsibility as a veterinary surgeon to protect and act in the best interests of animal welfare, and that he maintained he had no responsibility for the animals on his practice premises – an assertion referred to as ‘an extraordinary position for a veterinary surgeon to take’. 

Ian Green, chairing the Committee and speaking on its behalf, said: "ust as the judgment of the Crown Court and the Magistrates Court had found, the Committee also found that Dr Samuel must have known that the animals were in distress and were in a neglected state. The Committee was sure that Dr Samuel must have been aware of the animals notwithstanding his continued denial. The Committee concluded that Dr Samuel was unfit to practise because of the facts underlying the convictions. Dr Samuel had an overriding duty of care for the animals and to take action in relation to their health and welfare because they were living under the roof of his veterinary practice."

In considering its sanction against Dr Samuel, the Committee concluded that removal from the Register was the most appropriate option. It took into account the fact that the animals were found starving in a cellar without water, that Dr Samuel had not demonstrated insight into the serious nature of his offences, that he continued to deny responsibility and, furthermore, found no evidence that he no longer posed a risk to animals in the future. 

Ian Green added: "The Committee decided that the behaviour found proved was fundamentally incompatible with being a veterinary surgeon because in this case there had been a serious departure from standards as set out in the RCVS Code of Professional Conduct for Veterinary Surgeons…. Furthermore, there had been serious harm caused to a number of animals and a risk of harm to a number of other animals."

Dr Samuel has 28 days from being informed of the Disciplinary Committee’s decision in which to make an appeal to the Privy Council.

The Committee’s full decision and findings can be found here

The RCVS has announced that next month, it will be asking veterinary surgeons and nurses for their view on a proposed new framework for post-registration veterinary nursing qualifications which aim to enhance the structure of the veterinary nursing career and introduce an Advanced Veterinary Nurse status.

The proposed framework has grown out of the VN Futures research project, run jointly with the BVNA, which identified developing a structured and rewarding career path for veterinary nurses as one of the key demands of the profession.

It has been developed by the VN Futures Post-Registration Development Group in conjunction with the RCVS Veterinary Nurses Education Committee and Veterinary Nurses Council.

The College says the proposed framework is designed to provide accessible, flexible and professionally relevant post-registration awards for veterinary nurses in order to provide an enhanced level of veterinary nursing practice, while also providing specific modules that veterinary nurses at all career levels can study independently for their continuing professional development (CPD).

Julie Dugmore, Director of Veterinary Nursing at the RCVS, said: "One of the strongest messages that came out of the research we conducted with the British Veterinary Nursing Association prior to the publication of the VN Futures Report was that there was a need for a more structured and rewarding career path for veterinary nurses.

"Throughout the VN Futures roadshow events nurses felt they were often entering a career cul-de-sac after a certain amount of time in practice and so the need for further post-registration qualifications which promote excellence and recognise advanced knowledge, skills, competency and experience in designated areas were strongly expressed.

"We have taken this feedback and developed it into a comprehensive framework for two defined post-registration qualifications and are very interested in hearing what both veterinary nurses and veterinary surgeons have to say about all aspects of what we are proposing.

"Once we have collated the responses, we will incorporate the feedback into the framework for further consideration by the relevant committees and VN Council. The eventual aim is that these qualifications will, once sufficiently bedded in, lead to the development of an Advanced Veterinary Nurse status so that members of the VN profession with the sufficient skills and experience will get the recognition they truly deserve."

The two new qualifications included in the framework are a Graduate Certificate in Advanced Veterinary Nursing and a Postgraduate Certificate in Advanced Veterinary Nursing. Details of the courses’ structure, candidate assessment criteria, accreditation standards, student support, candidate eligibility rules, the RCVS enrolment process and the procedures for certification will be set out in a framework document as part of the consultation process. 

The document also includes a prospective list of designations for the two courses covering areas of advanced veterinary nursing knowledge such as wellness and preventative health; rehabilitation and physiotherapy; anaesthesia and analgesia; triage, critical care and emergency nursing; pharmacology; animal welfare; education and teaching; management and leadership; research; and, dentistry. 

The consultation will be launched in early July with an email sent to all veterinary nurses and veterinary surgeons containing a link to the survey and asking for their views on the proposals. Details of the consultation, once launched, may also be found at www.rcvs.org.uk/consultations 

The VN Futures Report is available to download from www.vetfutures.org.uk/vnfutures

RCVS Council has agreed a 3% increase in the registration and retention fees for veterinary surgeons for 2019/20 which will now be submitted to the Privy Council for formal approval.

Fees will now be £340 for a UK-practising member, £170 for members practising outside the UK, £56 for non-practising vets under the age of 70, and free for non-practising vets over 70.

Restoration fees, charged in addition to retention fees, increase to £85 following voluntary removal, and £340 following removal for non-payment.

Lizzie Lockett, RCVS CEO, said: "This year we asked Council to agree a fee increase to help us prepare for unknowns such as Brexit, as well as fortify our proactive work to help support the professions.

"Over the past few years we have put increased resources into projects such as: Mind Matters, our mental health initiative; Vet Futures, our joint project with the British Veterinary Association; Vivet, our innovation hub; and our recently launched Leadership Programme. Unfortunately there has also been a rise in Disciplinary Committee hearings and we are having to allocate further funds to making our building fit for purpose, and so a small increase has been necessary.

"This still places us at the lower end of fees for regulatory bodies while providing a secure financial foundation."

Portsmouth-based Simon Wood has been struck off by the RCVS Disciplinary Committee after being convicted of possessing indecent images of children.

Mr Wood was convicted of three offences which involved the download of 38 videos and 13 indecent images of children, at Portsmouth Magistrates’ Court in December 2017.

In January 2018, he was sentenced to a three-year Community Sentence for each offence, to run concurrently, and was made subject to a five-year Sexual Harm Prevention Order.

He was also fined £1,000 and ordered to pay costs of £340 and a victim surcharge of £85.

Mr Wood was also placed on the barring list by the Disclosure and Barring Service and required to register with the police pursuant to the Sexual Offences Act 2003 for a period of five years.

Mr Wood appeared before the Disciplinary Committee, admitted his conviction and accepted that it rendered him unfit to practise veterinary surgery.

In determining the sanction, the Committee says it took into account a number of mitigating factors: his conviction involved no actual harm or risk of harm to an animal; there was no financial gain; he had engaged in open and frank admissions at an early stage; he was experiencing mental ill-health at the time of the offence; he had taken subsequent steps to avoid a repetition of such behaviour; there had been a significant lapse of time since the incident; and he showed insight into the harm caused by his offence. 

The Committee also considered that the purpose of a sanction is not to punish, but to protect the welfare of animals, as well as maintain public confidence in the profession and declare and uphold proper standards of conduct. On consideration of the appropriate sanction, the Committee decided that postponement of judgement was not appropriate, and that taking no action was not an option. 

The Committee then considered whether a reprimand or warning was appropriate, but they considered that would not match the gravity of the offence – a period of suspension would also mean Mr Wood would automatically return to the Register after the period of time without the College being able to review his fitness to practise, rendering it an inappropriate sanction. The Committee therefore determined that the removal of Mr Wood from the RCVS Register was the only way to protect the wider public interest and maintain confidence in the profession.

Ian Green, chairing the Committee and speaking on its behalf, said: "The Committee has not taken this decision lightly, and, lest it be misinterpreted, it has not taken it in order to satisfy any notional public demand for blame and punishment.

"It has taken the decision because in its perception, the reputation of the profession had to be at the forefront of its thinking and ultimately it was more important than the interests of the Respondent.

"The decision is not simply based on the fact that these offences were of a sexual nature but because they were repeated frequently over a significant period of time, and at the time, the Respondent knew on his own admission that what he was doing was wrong.

"Accordingly, the Committee had decided that removal from the Register is appropriate and proportionate in this case. The Committee will direct the Registrar to remove the Respondent’s name from the Register forthwith."

Mr Wood has 28 days to appeal the Committee’s decision after which, if no appeal is received, the Committee’s judgment takes effect.

Republic of Ireland-based Gary Adams has been suspended from the Register for two years after he was convicted of 34 charges related to prescribing veterinary medicines.

Mr Adams was convicted at Gorey District Court, County Wexford, Republic of Ireland in March 2015 for:

• Nine offences of prescribing animal remedies to animals not under his care;

• Five offences of forging entries in official animal remedies records owned by farmers to suggest he had made visits to farms when he had not;

• Seven offences of dispensing a prescription-only animal remedy but not preparing a veterinary prescription containing the details of the animals;

• Two offences of failing to affix labels in the required form to prescription-only items when selling or supplying animal remedies;

• Six offences of failing to annotate the dispensed prescriptions with the word ‘dispensed’ and failing to sign and date them;

• Three offences of failing to keep a record or purchases and sales (including quantities administered) in respect of each incoming and outgoing transaction; and

• Two offences of selling animal remedies on a wholesale basis without an animal wholesaler’s licence.

The charges related to treatment of animals not under his care throughout 2012 and 2013 which were investigated by the Department of Agriculture, Food and Marine in the Republic of Ireland. 

In relation to these convictions Mr Adams received a 12-month prison sentence, suspended for two years, was fined a total of €40,000 and ordered to pay costs of €16,400. 

Following his conviction his conduct was considered by the Veterinary Council of Ireland’s (VCI) Fitness to Practice Committee and, in September 2017, the VCI a sanction of 12 months’ suspension from its Register. This sanction was upheld by the High Court in the Republic of Ireland in November 2017.

As well as being a registered veterinary surgeon in the Republic of Ireland, Mr Adams was also on the UK-practising Register with the RCVS, so his convictions were considered under the College’s own complaints and disciplinary process.

At the outset of the hearing, Mr Adams admitted the charges and accepted his convictions rendered him unfit to practise. The College also asserted that Mr Adams' convictions rendered him unfit to practise, noting a number of aggravating factors including the risk of injury to animals, dishonesty, premeditation, financial gain and misconduct sustained and repeated over time. 

In considering the College’s case and Mr Adams’ own admissions, the Disciplinary Committee agreed that his conduct rendered him unfit to practise veterinary surgery. 

Professor Alistair Barr, chairing the Committee and speaking on its behalf, said: "The Committee found the conduct to be at the serious end of the spectrum for such misconduct, it being systematic, prolonged and illegal conduct relating to the supply of animal remedies which posed a significant risk to human and animal health.

"Accordingly, the Committee found that the convictions which led to these charges cumulatively render Mr Adams unfit to practise."

In considering the sanction, the Disciplinary Committee took into account a number of mitigating factors including that he had been practising since 1993 and had no previous disciplinary findings, had made open and frank admissions at all stages to the College and had practised between April 2013, when the matters first came to light, and February 2018, when he was suspended by the Veterinary Council of Ireland, without incident. 

It also considered the conditions that were imposed upon Mr Adams by the VCI in terms of notification that he was intending to return to practice, auditing of his practice, his continuing professional development (CPD) and having to undertake personal and professional support programmes and arrangements for professional mentorship for one year after his return to practice. 

In view of the sanctions already imposed by the court in Ireland, and his suspension by the VCI, the Disciplinary Committee decided that a period of two years’ suspension from the UK Register of Veterinary Surgeons was the appropriate sanction.

Professor Barr said: "Whilst Mr Adams would be able to practise in the Republic of Ireland before he was able to practise in the United Kingdom again, the Committee considered that the conditions attached to his supervision in Ireland meant that he would be subject to close supervision before he was allowed to practise again in the United Kingdom and that only a longer period of suspension would allow this to happen.

"The Committee therefore decided that only a suspension of two years would maintain public confidence in the profession and declare and uphold proper standards of conduct for the serious nature of these charges."

Mr Adams has 28 days from being informed about the Disciplinary Committee’s decision to make an appeal to the Privy Council.

Suffolk-based Dr Horia Elefterescu has been struck off by the RCVS Disciplinary Committee for dishonesty, clinical failings and poor record keeping.

The Committee heard seven charges against Dr Elefterescu. The charges were:

1. In September 2015, in relation to a male cat called Kitty Brown, he failed to undertake an adequate examination prior to surgery and that he undertook an unnecessary laparotomy.

2. In February 2016, in relation to a male cat called Storm Page, he failed to undertake an adequate clinical examination prior to anaesthesia and made dishonest or misleading entries in the clinical records stating that he had undertaken a full clinical examination.

3. In February 2016, in relation to a male cat called Sampson Page, he failed to undertake an adequate clinical examination prior to anaesthesia and made dishonest or misleading entries to the effect that he had undertaken a full clinical examination.

4. In February 2016, in relation to Tibial Plateau Levelling Osteotomy (TPLO) surgery performed on a female Bichon Frise called Lucy Allen, he failed to undertake adequate examinations into the possibility of a cranial cruciate ligament rupture or failed to record the same; performed the TPLO surgery with insufficient clinical justification; performed the surgery inadequately; failed to take steps to rectify inadequate surgery having obtained post-operative radiographs; made dishonest/ misleading entries into clinical records; and, in a letter to the RCVS on 7 August 2016, made dishonest and misleading comments.

5. In February 2016, in relation to a male cat called Kipper Morley, he failed to take and record a sufficiently detailed history; failed to undertake an adequate clinical examination; that, having noted the possibility that Kipper might have anaemia, he failed to make arrangements for urgent investigations to be undertaken; that, having decided to administer intravenous fluids to Kipper, failed to make arrangements urgently; and failed to keep clear, accurate and detailed clinical records.

6. Between September 2015 and February 2016, he failed to keep clear, accurate clinical records in relation to seven cases.

7. In February 2016, in relation to a male cat named Chino Biggs, he failed to undertake adequate clinical examination and dishonestly made entries in the clinical records saying that he had undertaken aspects of an examination when he had not done so.

Having heard evidence from complainants, witnesses (including expert witnesses) and the respondent himself the Committee determined that the facts of all the charges were proven – with the exception of part of Charge 6 regarding his keeping inadequate clinical records in relation to a male cat called Dax Parham.

The Committee then went on to consider whether the proven charges, both individually and cumulatively, amounted to serious professional misconduct. In relation to the first and fifth charges the Committee found that, while Dr Elefterescu’s conduct fell below what was expected of a professional veterinary surgeon – they did not constitute serious professional conduct.

In relation to the parts of the second, third, fourth, sixth and seventh charges that were found proven, the Committee determined that each constituted serious professional misconduct. 

In relation to these determinations, Ian Arundale, chairing the Committee and speaking on its behalf, said: "The respondent’s clinical failures… are very serious, amounting as they do to failures in the basics of animal care and resulting in suffering to the animal. They involve widespread breaches of the Code, including not only the obligation in relation to animal health and welfare… but also the specific obligations of the Code in relation to record keeping. 

"In addition to his clinical and record keeping failures the respondent has been found to have acted dishonestly. This dishonesty would have impacted upon professional colleagues and any owner who viewed the records. It has the potential to undermine public confidence in the profession. The respondent was also dishonest in a letter written in August 2017 to his regulator."

In considering Dr Elefterescu’s sanction, the Committee took into account a number of aggravating and mitigating factors.

Aggravating factors included actual and risk of injury to animals, dishonesty, recklessness, breach of client trust, repeated misconduct and limited insight into his failings.

In mitigation the Committee considered that, at the time of the misconduct, the respondent was new to the UK, he had language difficulties which resulted in communication problems, that he was unfamiliar with UK veterinary computer systems and procedures, that he is of good character, that he has taken steps to avoid a repetition of his misconduct and that there have been no subsequent complaints since the dates of the matters in the charges.

However, the Committee found that, in light of the seriousness of the charges found against him, the only sufficient sanction was to direct the Registrar to remove Dr Elefterescu’s name from the Register. 

Mr Arundale, commenting on the sanction, said: "The respondent’s misconduct involved very serious departures from the professional standards set out in the RCVS Code…. In particular, the unnecessary surgery (both the initial and revision) carried out on Lucy Allen constituted very serious harm to an animal. The Committee considers that the respondent’s lack of insight into his failings, and his wholly unjustified confidence in his abilities constitute an ongoing risk to animal welfare. In these circumstances, the Committee has determined that the only sanction which is appropriate and proportionate, in order to ensure the welfare of animals, the public interest and the reputation of the profession, is to direct the respondent’s removal from the Register."

Dr Elefterescu has 28 days in which he can lodge an appeal with the Privy Council regarding the Disciplinary Committee’s decision.