Two more companies have now joined Pawsquad in announcing the launch of online veterinary consultations for pet owners.

First out of the stalls was Vet AI, a company founded in 2017 by Paul Hallett and Robert Dawson MRCVS, which announced last November that it had filed patents for artificial intelligence technology to deploy in giving online consultations through its newly-launched app: Joii.

More recently, a Swedish company called FirstVet has announced the UK launch of a consultation service it has offered in the Scandinavian countries for a few years now. 

All three companies charge £20 for an online consultation with a veterinary surgeon.

All of these services are currently limited in what they can offer pet owners here in the UK, because veterinary surgeons are not allowed to prescribe medicines without having physically examined the patient. FirstVet says that in Sweden, similar rules apply, except that under current guidance, antiparasiticides and feline contraceptives can be prescribed remotely.

This means that for the moment at least, online consultations in the UK can only advise pet owners whether they do or do not need to see a veterinary surgeon in person, or recommend OTC treatments, such as flea control. 

Personally, I'm not convinced that it's worth £20 for the privilege of asking a vet whether or not my pet needs to see a vet, although to be fair, Joii includes a free symptom checker to differentiate between those cases that need directing to see a vet in person, and those that would benefit from the online consultation. Also, if a case needs to be referred to another vet after a consultation, Joii refunds the consultation fee. 

Nevertheless I think I'd just ring my normal practice and ask. But that's just me. Perhaps others will see a value in the immediacy of the online service, or that it entails less commitment.

FirstVet does, however, have another string to its bow. It has been busy forging relationships with insurers to fund the majority of its consultations. The insured owner gets a free consultation subsidised by the insurance company; if the animal requires treatment, the owner is referred to their normal vet, unless they don't have one, in which case the referral is to the nearest practice which can help.

That seems to make all sorts of sense for insured clients. It really adds value to the insurance policy, to be told you'll have access to free, immediate online veterinary consultations. Almost certainly it will mean pet owners seeking veterinary advice sooner than they might otherwise have done. For the insurer, that in turn might mean earlier diagnosis and therefore cheaper treatment. One assumes it also translates into cost-savings for the insurer by dealing with certain queries without needing a trip to the practice.

Still, the really big prize here for remote consultation companies will come if and when the regulations allow remote prescribing. Not necessarily because they'll make a mark up on the sale of prescription drugs, though of course they will, but because suddenly the proposition to the pet owner is that the consultation can, in many cases, offer more convenient and cheaper treatment than if they had to visit a practice in person.

The problem with that, however, is that the £20 remote consultation may carry a greater risk of misdiagnosis. It may mean that the preventative approach to veterinary medicine goes out of the window, at least until remote monitoring technology catches up. There is also a risk that these new limited service providers will take the bread and butter consultations from bricks and mortar practices, consultations that may have been to some degree subsidising care for other patients. These are all the sorts of things that were hotly debated at RCVS Council last November. 

Nevertheless, Vet AI is unashamedly pushing for remote prescribing rules to be relaxed. Founder Robert Dawson MRCVS said: "I think that the ease and reduced cost of access to veterinary advice and medicines will have a positive impact on animal welfare. I also think that it will free up vets' time to see the cases they really need to see.

"But in truth, what I think is not the point. The whole debate at the moment is characterised by members of the profession saying what they think will happen as a result of remote prescribing. What we actually need is some evidence. I'd really like to see some movement from the College on this, for a limited number of treatments like parasiticides, before the end of the year."

As Robert says, the debate is characterised by a lack of evidence. But there is, of course, another way that online consultations could really add value to the client/vet relationship without any of these problems, and that is as an adjunct to the service offered by bricks and mortar practices. 

Bricks and mortar practices can already prescribe medicines to animals under their care without physically seeing the animal on every occasion. Furthermore, there are a number of situations where a remote consultation could save both the practice and pet owner time and money. For example, post-operative follow-up consultations.

However, none of the existing providers I've spoken to plan to offer a 'white label' solution. So, if I owned a practice, I tell you what, I'd be looking into online consultation software right now. It is already possible, of course, to offer online consultations via things like Skype. But better still would be a system that allowed clients to schedule an online appointment with their normal vet, perhaps slotted in between their face-to-face consultations. As opposed to the existing online providers, you wouldn't need to refund money if a physical consultation was needed, just - perhaps - set it against the later consultation. You could also offer annual plans to include a certain number of online consultations. You could have online triage consultations carried out by veterinary nurses. 

There are lots of possibilities. But if you're a bricks and mortar practice, one thing is for sure, the time to look into all this is now. You could do worse than to start here: https://www.vetsurgeon.org/news/b/veterinary-news/archive/2019/01/15/now-all-vet-practices-can-offer-remote-consultations.aspx

Eurovet has launched Comfortan, the first EU-authorised methadone in the UK, available as an injectable solution for use in dogs.

Eurovet says that whilst methadone may seem an unfamiliar analgesic choice for some vets in practice, that is about to change very quickly.

Ruth Vernon Technical Services Manager at Eurovet says that prior to the launch of Comfortan, reports show that usage of methadone to manage pain in animals is much higher than previously thought: "We have become aware that many practices are using methadone routinely for orthopaedic procedures and that several specialists use it in preference to any other analgesic where rapid onset of action and profound analgesia is important. This opioid provides vets with an animal analgesic with very rapid onset of action: exerting an effect in just 10 minutes of intravenous administration and 15 minutes of intramuscular administration. Comfortan is licensed both as an analgesic and as a premed in combination with a neuroleptic drug. As a full opioid agonist, Comfortan results in very effective pain relief, particularly when used for moderate to severe pain. Comfortan provides pain relief for approximately four hours and can be re-dosed to achieve the desired level and duration of pain relief."

Ruth is anticipating high demand for Comfortan from launch: "Comfortan enables many more patients to be given methadone immediately to control their acute pain without their vets having to go through lengthy protocols involved in using products off-licence, so we think that more vets are about to become convinced of the benefits.  Comfortan is licensed for veterinary use and it offers the convenience of a 10 ml vial with a shelf life of 28 days. Those who have not used methadone before, or indeed anyone with a query about storage or monitoring, can source all the information and advice they need by contacting us at Eurovet Animal Health."

For further information contact Eurovet Animal Health on 01223 257933, e-mail: office@eurovet-ah.co.uk, or visit: http://www.eurovet-ah.co.uk/

A consultation held earlier this year by the RCVS has found that both veterinary surgeons and nurses overwhelmingly think nurses should be able to perform additional tasks that are not currently permitted under Schedule 3 of the Veterinary Surgeons Act 1966.

The consultation invited members of the professions to explain how they currently understand and interpret Schedule 3 in practice, how it could be clarified and how it might be amended to bolster the veterinary nursing profession. 

11,625 people responded to the consultation, the highest number that has ever responded to an RCVS consultation. 6,873 were veterinary nurses (around 35% of the profession and including 1,665 student veterinary nurses) and 4,752 were veterinary surgeons (around 21% of the profession).

The report on the consultation, which is published today by the Institute for Employment Studies, found that 92% of veterinary nurses and 71% of veterinary surgeons think veterinary nurses should be able to undertake additional areas of work.

However, neither vets nor nurses seem to have an especially good understanding of the current scope of Schedule 3 and how it applies in practice, rating their personal understanding at 5.6 and 6.7 out of 10 respectively.

When asked what prevented the full utilisation of veterinary nurses, the majority of both vet and vet nurse respondents highlighted a lack of understanding of what tasks can be delegated under Schedule 3, with around 60% of veterinary surgeons also admitting that they are not good at delegating.

61% of veterinary nurses and 50% of veterinary surgeons thought that the RCVS gives sufficient support and advice about Schedule 3, though the relatively poor level of understanding amongst veterinary surgeons in particular suggests more needs to be done.

In corresponding comments both veterinary nurses and veterinary surgeons said they would like more clarity, especially around 'grey areas' such as the meaning of the term 'minor surgery', as well as further communication from the College about Schedule 3 and for more training for veterinary nurses to ensure they have the competence and the confidence to carry out delegated procedures.

Liz Cox, Chair of RCVS Veterinary Nurses Council, said: "Thank you to all those who responded to the consultation in such large numbers and who shared their views on this topic. The consultation grew out of the government’s suggestion that we review Schedule 3 as a means of bolstering the VN profession, and from the VN Futures project last year, when Schedule 3 was identified as an area where there could be some additional work to clarify the rules around delegation to veterinary nurses.

"There was a clear consensus that veterinary nurses could do more in their role and under Schedule 3 and so we will be feeding the findings back to the RCVS Legislation Working Party, which will be looking, in the round, at possible changes to the framework of veterinary legislation, including how it applies to veterinary nurses and other paraprofessionals.

"In terms of the understanding of Schedule 3 and how it applies in practice it is clear that we need to do some further work to clarify the rules and develop guidance to assist both veterinary nurses and veterinary surgeons in exercising their professional judgement in respect to delegation, for example, through case studies and other examples." 

Looking at the tasks currently performed by veterinary nurses, the survey found the five most commonly performed are: clinical cleaning (92%), administration of medicines by subcutaneous injection (91%), administration of medication (90%), monitoring of anaesthesia (86.5%) and administration of medicines by intramuscular injection (86%).

The consultation also found that the majority of veterinary nurses are involved in clinics aimed at educating animal owners on various different aspects of animal health and welfare. The most common include puppy/kitten care (66.5% of respondents), nutrition (65% of respondents), general check-ups (62.5% of respondents) and dental care clinics (57% of respondents).

Post-survey interviews with 10 veterinary nurses and 10 veterinary surgeons found a number of recurring themes, including: limited career paths for veterinary nurses; poor pay for VNs relative to their training and complexity of work; lack of recognition and appreciation for the VN role; enthusiasm for advanced practitioner and specialist status for VNs; and difficulty recruiting experienced VNs.

The College says the results of the consultation will now be considered by the RCVS Schedule 3 and Legislation Working Parties, which are reviewing the efficacy of the current Veterinary Surgeons Act and whether changes need to be made to bring the legislative framework for the profession up-to-date, including consideration of the part played by allied professions like veterinary nurses in the veterinary team.

The full report can be downloaded here.

Researchers at the University of Bristol’s School of Veterinary Sciences have published a new paper which argues that veterinary professionals need to move away from giving advice in a paternalistic, directive, persuasive manner, and instead adopt a more collaborative, partnership-based style.

The researchers say that when veterinary surgeons give advice to clients with the aim of changing their behaviour - such as encouraging them to feed their pet differently - they often speak in a directive style, which is driven by a paternalistic-type relationship.

This, they say, reduces a client’s sense of emotional connection to their vet, whilst limiting their personal choice and self-direction in the decision-making process. This consultation method, combined with its conflict with these basic motivational drives, may contribute to why low uptake of veterinary recommendations are reported throughout the profession.

One solution could be the use of evidence-based communication approaches that have been tried and tested in the medical profession.

Alison Bard, PhD researcher at the School of Veterinary Sciences, said: "Veterinarians are working hard to connect with their clients and promote the health of animals in their care, but being a veterinarian is not just about communicating science and methodology. Communication must also inspire motivation, prompt action and boost confidence for an animal carer to put veterinary advice into practice.

"The problem our research identified is that the perceived role of the veterinarian - to provide advice and solutions – leads to a personal communication style that leaves little room for empathy or client input. This style comes at a high cost for client engagement with advice, as we know from wider research that relational interaction and active participation of clients is essential for inspiring a change in behaviour. For the typical veterinarian, this may be surprising, as the clinical accuracy and relevance of advice has traditionally (and intuitively) been the focus of advisory services."

The research team believes a shift in veterinary surgeons' perceptions of advisory consultations is needed to improve the uptake of advice.

Alison added: "As a profession, veterinarians can benefit from recognising that behaviour change is incredibly complex. Being provided with the ‘right’ advice is not always enough for clients to put veterinary recommendations into action, especially where disease management is complicated and clients have mixed feelings over treatment options. How information is communicated in these cases affects client outcomes, meaning the difference between a motivated and unmotivated client can - in fact - be shaped by the veterinarian."

The research team hopes that this study will help veterinary surgeons think differently about their consultations by encouraging them to consider how their communication may be influencing client motivation and behaviour. As a result, they hope veterinarians will think carefully before using labels like  ‘unmotivated’ or ‘resistant to advice’, and instead explore whether their clients are perhaps just in need of emotional support, personal choice or a sense of self-confidence to truly engage with veterinary recommendations.

This call for change in the veterinary profession is already underway as a result of the VetFutures project, launched in 2015. This project called for a change in veterinary consultation style: away from a hierarchical model with the veterinary surgeon as the expert passing on instruction, to a model centred on partnership to create empowered and motivated clients.

Bristol’s research will inform this focus of the VetFutures project, and this study provides further evidence about the consequences of paternalistic communication on motivation and behaviour change in veterinary clients.

Dr Kristen Reyher, Senior Lecturer in Farm Animal Science, said: "This paper is one element of an exciting research project that will help inform and support our evolving veterinary profession. I’m confident that change can be achieved with the help of ongoing research. Our interdisciplinary work is focused on whether Motivational Interviewing - an evidence-based communication method that fosters a mutualistic approach to conversations on behaviour change - can deliver the advances VetFutures imagine for our colleagues of the future.

"We look forward to providing further evidence to contribute to a professional shift that will enhance the experience and wellbeing of veterinarians, clients and the animals in their care."

Reference

1. The future of veterinary communication: Partnership or persuasion? A qualitative investigation of veterinary communication in the pursuit of client behaviour change’ by Alison M. Bard et al in PLOS ONE

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 Disciplinary Committee has suspended a veterinary surgeon formerly practising in Southampton for failing to make animal welfare his primary concern.

At a hearing this week, adjourned from September 2010, the Disciplinary Committee heard charges against Michael Albring, formerly of VetCall practice, Bitterne, Southampton. Mr Albring was said to have failed to make a home visit to attend Bear, a Newfoundland dog belonging to Mrs Thacker, when he knew, or ought to have known, that there were clinical or welfare grounds making a home visit necessary.

The hearing was held in Mr Albring's absence; the Committee considered that, having postponed the case last year at his request, Mr Albring had had ample time to prepare his case and submit any mitigations, and sufficient opportunity to attend. Additional adjournment would further delay the matter's resolution and not be in the wider interests of justice, or public confidence in either the RCVS disciplinary system or the veterinary profession.

On the evening of 19 December 2009, Mr Albring had been the veterinary surgeon on duty at VetCall, a practice that provides the out of-hours emergency cover for several local veterinary practices, including the one where Bear was registered. When Mrs Thacker's daughter, Ms Davidson, telephoned VetCall to request a home visit as the dog had collapsed, she was told that it was against practice policy for the practice to be left unmanned so this would not be possible. This was despite a written policy which accepted and made provision for the rare occasions when a home visit would be necessary. Phoning again later, the information about practice policy was repeated and Ms Davidson directed to a local animal ambulance service, which attended.

The ambulance driver found that the dog could not be transported in the ambulance and telephoned VetCall to say a home visit was needed. This was refused by Mr Albring even, the Committee noted, when the ambulance driver offered to collect Mr Albring, drive him to Ms Davidson's home 10-15 minutes away, assist with the euthanasia, and return him to the clinic. In the interim, Ms Davidson had also sought help from a separate practice and, subsequent to Mr Albring's refusal to visit, their on-duty veterinary surgeon attended and euthanased Bear. 

The Committee found that Mr Albring's refusal to visit, once it was clear Bear could not be transported, and he knew that a home visit was necessary on welfare grounds, resulted in Bear spending longer than necessary in pain and distress. This was not a case where the pressure of work or the welfare needs of other animals prevented Mr Albring from attending, and it was also relevant that Mr Albring was specifically employed to work out of hours in an emergency clinic. Serious, too, was his failure to reply promptly to communications from the RCVS, or show insight into the seriousness of his conduct.

In mitigation, the Committee accepted that this was an isolated case, and there were no previous findings against Mr Albring.  He was in sole charge of an emergency clinic covering 15-20 practices across Southampton and Portsmouth, which would make, in some circumstances, home visits difficult.

Professor Sheila Crispin, chairing the Disciplinary Committee, said: "The Committee is concerned that the actual policy pursued by the clinic regarding domiciliary visits was different to the written one.

"In effect, a no-visits policy existed at the VetCall clinic and this must have added to the pressure under which the Respondent [Mr Albring] was working.

"The Committee is mindful that the object of sanctions is not to be punitive, but to protect animal welfare, to maintain public confidence in the profession and to maintain appropriate standards," she continued, noting that as animal welfare had knowingly been neglected and Mr Albring had demonstrated no insight, a warning or reprimand would not be enough.  "A period of suspension would be sufficient to maintain public confidence in the profession and uphold standards," she said.

The Committee directed that Mr Albring's name be suspended from the RCVS Register of Veterinary Surgeons for ten months.

A group of UK-based investigators from Davies Veterinary Group and the UCL School of Pharmacy has published the results of a study which suggests Keppra (levetiracetam) shows promise for the treatment of feline audiogenic reflex seizures (FARS).

The condition, which was first documented by the same investigators last April, affects older cats which typically exhibit myoclonic seizures (brief, shock-like jerks of a muscle or a group of muscles) in response to certain high-pitched sounds. Both non-pedigree and pedigree cats (in particular, Birmans) may be affected. A range of sound stimuli has been reported, including the crinkling of tin foil and a metal spoon dropping into a ceramic feeding bowl, through to firewood spitting and even texting on a phone. While avoiding the triggering sounds can reduce the incidence of seizures, this is not always practical, so this research is potentially good news for owners of affected cats.

The study, Levetiracetam in the management of feline audiogenic reflex seizures: a randomised, controlled, open label study, has been published in the Journal of Feline Medicine and Surgery¹.

It compared the efficacy of two antiepileptic drugs, levetiracetam (a relatively novel medication that has proven effective in studies of people with generalised epilepsies that experience myoclonic seizures) and the much older first generation drug phenobarbital, in 57 cats diagnosed with FARS. Cats were treated with one or other drug over a 12 week period; and owners were asked to record the date, number and type of seizures, any signs of illness, side effects and changes in activity or attitude, as well as whether they thought their cat's quality of life had improved, remained the same or deteriorated since starting the medication. 

All cats receiving levetiracetam showed a reduction in the number of days that they experienced myoclonic seizures by at least half. In comparison, only 3% of cats showed the same reduction when treated with phenobarbital. The majority of reported side effects, such as lethargy and inappetence, were mild to moderate in both groups and these resolved after about 2 weeks in the cats treated with levetiracetam; in the phenobarbital group, however, side effects were relatively persistent. Owners of cats treated with phenobarbital perceived no benefit from using the medication; in contrast, all of the owners of cats treated with levetiracetam commented that their cat appeared brighter and more responsive after the first couple of weeks of treatment. Moreover, five cats treated with phenobarbital were switched to levetiracetam after the study, as their owners desired improved seizure control. 

Having established that levetiracetam is an effective and well-tolerated treatment for cats with hallmark myoclonic seizures, the next step is to identify whether levetiracetam will also prevent so-called generalised tonic–clonic seizures. This is another seizure type seen in cats with FARS, and is what most people think of as a 'seizure', with the cat losing consciousness and its body stiffening and jerking, often for several minutes. 

Lead author on the paper, Mark Lowrie, said: "It is great to find a medication that works so well at controlling these seizures. Levetiracetam is not licensed in cats but it has proven to be a very safe drug. For affected cats to benefit, it is important that vets recognise the signs as this newly defined syndrome of FARS and that this medication is used in preference to other, less efficacious, anti-epileptic drugs."

Reference

1. Lowrie M, Thomson S, Bessant C, Sparkes A, Harvey RJ and Garosi L. Levetiracetam in the management of feline audiogenic reflex seizures: a randomised, controlled, open-label study. J Feline Med Surg. Epub ahead of print 21 December 2015. DOI: 10.1177/1098612X15622806.

A survey carried out by VetSurgeon.org and VetNurse.co.uk has found that over 70% of the calls from pet owners to veterinary surgeons after hours are unnecessary.

For the survey, veterinary surgeons and nurses were asked: "Thinking about the last time you (or your OOH provider on your behalf) were called by a pet owner out-of-hours within the last fortnight, was the call ...

a) Something which was clearly NOT an emergency (eg vaccination, nail clip, dematt, pet passport etc.)

b) A condition which should have been seen in normal working hours (either because it has been present for some time already with no deterioration or because - in your opinion - it could have waited till the morning).

c) A genuine emergency, which needed prompt attention to prevent the animal suffering.

475 members took part, 69% of which were vets and the remainder vet nurses. 

Of the out-of-hours (OOH) calls they had taken: 

28.2% were genuine emergencies, which needed prompt attention to prevent the animal suffering.

64.8% were about a condition which should have been seen in normal working hours (either because it has been present for some time already with no deterioration or because it could have waited till the morning).

6.9% were about something which was clearly NOT an emergency (eg vaccination, nail clip, dematt, pet passport etc.)

So in total, 71.7% of the calls to veterinary surgeons OOH are unnecessary.

This raises a number of important questions, chiefly whether a profession struggling with a staffing crisis can afford to maintain the blanket requirement for all practices to make provision for OOH, particularly now that society places so much greater demands on the profession than it did when the rules were invented, demanding wormers in the middle of the night and then blackening the name of the vet on social media if they refuse. It happens.

Is it time to go the same way as some other countries and let the market meet the demand? 

Or can anything else be done to relieve the pressure that OOH places on the profession? Ideas floating around include making all veterinary OOH telephone lines premium rate, charging at least enough to focus the caller's mind on whether it is actually necessary to renew their pet passport at 3:00am. Or perhaps a concerted effort by all parties to communicate the message that OOH is A&E. You shouldn't ring unless you really need to. But that message may not carry much weight when at the end of the day, it's the insurance company footing the bill.

Reducing the number of spurious calls doesn't, of course, help the staffing crisis. But it is surely pertinent to ask whether an obligation for 100% of general practices to make arrangements to service something which is 70% unnecessary is the most efficient way to operate.

Maybe the time has come for the profession to consider OOH and general practice as two very distinct things. Discuss.

The RCVS didn't want to comment. 

Virbac has launched Multimin, a prescription only, four in one trace mineral injection to combat oxidative stress and its effects in cattle.

Oxidative stress is an imbalance of free radicals and antioxidants which can lead to cell and tissue damage, impacting the health and performance of cattle.¹ Virbac says the trace minerals in Multimin are essential structural components of antioxidant enzymes which are required to neutralise free radicals and combat oxidative stress.^2,3

Multimin, which comes in a 100ml PET bottle, contains zinc, copper, manganese and selenium. It is designed to be administered during or before periods of high demand in dairy and beef cattle, such as breeding, calving, weaning and vaccination. After injection, it reaches peak levels in the blood after 8 hours^4,5 and the liver after 24 hours.^4,5

Virbac says Multimin has been proven in 24 peer-reviewed papers and field trials of more than 6,000 cattle, and that it offers a fast, simple and accurate way to top up essential trace minerals at times of high demand, to help improve cattle health and performance.

Lynda Maris, Virbac Large Animal Product Manager said: "Trace mineral requirements are currently primarily provided through the diet and various forms of oral supplementation. However, reduced oral intake, poor absorption from the rumen and antagonism from other minerals means that during periods of high demand, even in apparently well supplemented animals, a trace mineral gap can occur between the trace minerals required for optimum health and performance versus those available."

Lynda added: "Multimin is a great addition to the Virbac Large Animal range. It represents an exciting new opportunity for vets to strengthen their herd health plans, boost practice revenue and help to further reduce antibiotic usage."

For more information, speak to your Virbac Territory Manager or visit the Virbac stand at the BCVA Congress, 17^th – 19^th October.

References

1. Celi, P. Oxidative stress in applied basic research and clinical practice (Eds.Armstrong, D., Mandelker, L. & Vajdovich, P.). Humana Press, 191–232 (2011). 
2. Hough, M. A. & Hasnain, S. S. Structure of Fully Reduced Bovine Copper Zinc Superoxide Dismutase at 1.15 Å. Structure 11, 937–946 (2003).
3. Rotruck JT, Pope AL, Ganther HE, Swanson AB, Hafeman DG and Hoekstra WG (1973) Selenium: biochemical role as a component of glutathione peroxidase. Science, 179 (4073):588–590. 
4. Pogge, D, Richter, E, Drewnoski ME, Hansen SL. Mineral concentrations of plasma and liver following injection with a trace mineral complex differ among Angus and Simmental cattle. J. Anim.Sci. 90, 2692–2698 (2012).
5. Study data on file. 

The RCVS Disciplinary Committee has reprimanded Hertfordshire-based Amir Kashiv MRCVS for the inadequate care of a dog with renal failure.

Mr Kashiv first appeared before the Committee in December 2016 in relation to four charges against him regarding his inadequate treatment of a Scottish Terrier called Tanzy which was ultimately euthanased due to renal failure.

The first charge related to Mr Kashiv’s original consultation with the owner in March 2015 and his failure to investigate for renal disease; his failure to discuss with the owner investigations to assess metastatic spread; failure to discuss with the owner alternative options to surgery such as palliative care or euthanasia and failure to explain to the owner key factors with regards to the surgery he had suggested to her, including its nature and extent, the risks involved, the fact another vet would be performing the surgery, and what to expect post-operatively.

The second charge related to the fact that, having admitted the dog as an in-patient at the practice, he failed to conduct further investigations regarding her poor condition; provide any or any adequate pain relief, or fail to record the same; failed to discuss with the owner the dog’s poor prognosis and failed to discuss with the owner the option of euthanasia.

The third charge related to the fact that Mr Kashiv discharged the animal back into her owner’s care when she was not in a fit state for discharge. The fourth and final charge related to the fact that Mr Kashiv failed to keep sufficient clear, detailed and accurate clinical records for his treatment of the dog. 

At his original hearing in December 2016, the Committee found the four charges proven and also found that charges 1 to 3 amounted to serious professional misconduct. However, the Committee decided to postpone the judgement for two years, whilst recommending that Mr Kashiv agree to undertake a structured programme to improve his clinical practice, including putting together a personal development plan, having a mentor, accepting regular practice visits and undertaking additional continuing professional development (CPD).

The resumed hearing took place on Tuesday 18 December 2018, during which the Committee heard evidence from Dr Writer-Davies MRCVS (the veterinary surgeon appointed to review Mr Kashiv’s practice and report back to the Disciplinary Committee over the two year period), Mrs Somers MRCVS, (his appointed mentor), and Mr Kashiv himself.

Dr Writer-Davies told the Committee that she had no concerns about Mr Kashiv’s abilities regarding patient safety and that, in her view, he now meets the standards of a reasonably competent veterinary surgeon. She cited the fact he had gained in confidence when communicating with clients, had undertaken a considerable amount of CPD focused on the areas of concern identified in the case, that she had observed more detailed record keeping from him and that a veterinary nurse had been appointed to assist in running Mr Kashiv’s practice.

The evidence from Mrs Somers also found that Mr Kashiv’s knowledge was in line with that expected of a reasonably competent veterinary surgeon and that she had observed a good quality of care for pets and their owners from him.

Mr Kashiv also gave evidence, which the Committee said demonstrated considerable insight into his previous conduct and a good attitude towards self-reflective practice. The Committee also felt that the testimonials provided by Mr Kashiv showed him to be a kind and caring veterinary surgeon.

Stuart Drummond, chairing the Committee and speaking on its behalf, said: "The Committee considers that, having successfully completed the undertakings, Mr Kashiv is now a safe practitioner. The last two years has allowed Mr Kashiv to develop his skills particularly in the area of communication.

"However, the Committee has not lost sight of the fact that this was a serious case and that there was substantial harm caused to Tanzy.

"The Committee considers that in the intervening two years Mr Kashiv has gained considerable insight, developed better communication skills and remains open to improving his practice. It therefore imposes a reprimand on Mr Kashiv. The Committee considers that a reprimand is the appropriate and proportionate sanction to uphold proper professional standards and to maintain public confidence in the veterinary profession."

Up to 80 staff are being recruited for Paragon Veterinary Referrals, a new £5 million referral centre in Wakefield, Yorkshire.

Paragon is being built by the Linnaeus Group, which says the new centre will be one of the largest and best-equipped in the UK when it opens its doors early in the New Year. 

The new centre follows the Linnaeus Group's acquisition of Dewsbury-based Calder Vets last year.

Calder Vets' existing referral teams, together with two ophthalmologists from its Mirfield branch, will be transferring to Paragon. Meanwhile, Calder Vets will move to solely first-opinion work. 

Currently nearing the end of construction, the centre will have eight consulting rooms, five operating theatres, MRI and CT scanners, intensive care facilities along with an all-digital imaging department. 

A total of up to 80 staff will be employed at Paragon, including up to 18 referral vets and 32 veterinary nurses.

Specialist services will include cardiology, neurology, ophthalmology and orthopaedic and soft tissue surgery. 

Positions currently available include a diagnostic imager, internal medicine specialist, neurology specialist, oncology specialist and an ophthalmologist, as well as various nursing posts. 

Ian Monteith, managing director of Paragon, said: "We are looking for the best possible people who not only have the right skills and experience, but who will also fit into the ethos we want to create at Paragon. 

"It is a significant and exciting opportunity for motivated, high calibre people to help shape something that has a very bright future for both the industry and for their own careers. 

"Our philosophy is very much one of friendly cooperation between all members of staff, creating a pleasant, supportive and good-humoured atmosphere."

For details of the vacancies currently on offer at Paragon, visit www.paragonreferrals.co.uk/en-GB/careers