Wirral practitioner Nigel Charles Hough MRCVS has been reprimanded by the RCVS Disciplinary Committee for failing to communicate adequately with clients in relation to the care of their dog and for speaking disparagingly about other veterinary practitioners.

The Disciplinary Committee made its decision last Friday, following an adjournment of the case, which was initially heard in May of this year.

There were three heads of charge against Mr Hough:

1. That between 6 May 2014 and 23 May 2014 he failed to provide appropriate and adequate care to Mya, a Staffordshire Bull Terrier in relation to two separate clinical procedures, in that:
   
   In relation to the first procedure, which took place on 7 May 2014, his operation to remove a primary mass from Mya’s right back leg was not clinically justified whilst he was aware that there were other small masses on the same thigh; and he failed to provide or ensure adequate overnight post-operative care to Mya following that procedure.
   
   In relation to the second procedure, which took place on 21 May 2014, the charges were that his approach to wound management and healing was inappropriate; he failed to provide adequate peri-operative care; and he discharged the dog on 22 May without taking adequate steps to ensure she was fit to be discharged.
   
   
2. That between 6 and 22 May 2014 he failed to communicate adequately with Mya’s owners, including failing to discuss a range of realistic treatment options, failing to provide adequate information as to Mya’s post-operative condition, failing to provide the owners with information on providing post-operative care and failing to provide them with details of out-of-hours cover.
   
   
3. On 1 June 2014, during a conversation with the owners, Mr Hough made a number of disparaging comments about other veterinary practitioners and practices.

The Committee found the majority of the first head of charge not proven, with the exception of the charges that Mr Hough failed to provide and ensure adequate overnight care for Mya and that it was inappropriate and unreasonable for him to plan for the wound management to be undertaken by Mya’s owners following the second procedure on 21 May 2014.

Regarding the second head of charge, the Committee found it proven that Mr Hough did fail to provide information about post-operative care and out-of-hours cover details to Mya’s owners. However it found Mr Hough’s failure to communicate with the owners regarding treatment options and to provide them with adequate information as to Mya’s post-operative condition not proven.

The third head of charge in its entirety was admitted and found proven.

The Committee also found that those charges that were found proven amounted to disgraceful conduct in a professional respect with the exception of Mr Hough’s failure to provide and/or ensure adequate overnight care and his failure to failure to provide out-of-hours details to Mya’s owners. 

In deciding on an appropriate sanction, the Committee expressed significant concerns over Mr Hough’s treatment of Mya, in particular his "failure to devise and implement proper and sufficient procedures to ensure that this dog was not released to owners unless it was safe for her to be released and... that the owners were fully advised as to what was required of them."

The Committee felt that Mr Hough had given "insufficient attention" to Mya’s post-operative care but did accept that the conduct represented a single incident. During the course of the hearing the Committee also heard mitigating evidence given on behalf of Mr Hough, with a number of written testimonials as well as witness evidence in support of his clinical expertise and surgical skills.

The Committee accepted that Mr Hough had taken to heart the lessons to be learnt from the charges against him and had implemented a number of written protocols to prevent recurrence of the shortcomings in his treatment of Mya. Furthermore, the Committee also found that Mr Hough had demonstrated insight into the conduct found against him and that he had apologised for the disparaging remarks he made about other veterinary practitioners.

Alistair Barr, chairing the Disciplinary Committee and speaking on its behalf, said: "In short, the Committee is persuaded that Mr Hough has made a good start in putting in place systems to ensure that the interests and welfare of the animals treated at his practice surgeries are not discharged from care until they are fully ready to be discharged and that the owners of such animals will, in future, be fully informed of what might be asked and required of them when their animals are returned into their care after surgery."

He added: "There are no other areas of [Mr Hough’s] professional practices which appear to the Committee to call for improvements. Accordingly, the Committee is persuaded on this evidence that there is reason to believe that the lessons which Mr Hough needed to learn have been learnt and concludes, therefore, that the sanction of a formal and solemn reprimand adequately meets the needs of the public interest in, and requirements of, this particular case. Mya did make a full recovery from her extensive surgery but she and her owners deserved better post-surgery advice and support."

The RVC has published the results of a study which showed that dogs treated with pimobendan at the preclinical stage of mitral valve disease (MVD) remained asymptomatic for an average 15 months longer and lived for significantly longer than the placebo group.

The EPIC study (Evaluation of Pimobendan In Cardiomegaly), published open access in the Journal of Veterinary Internal Medicine¹, is the largest prospective veterinary cardiology study carried out to date. The authors say that the quality of the data it produced rivals that of human clinical trials.

The study was double-blinded, placebo-controlled and randomised. It took seven years to complete and involved 360 dogs across 11 countries in four continents.

To qualify for enrolment in the study, dogs had to be 6 years of age or older, have a body weight ≥4.1 and ≤15 kg, have a characteristic systolic heart murmur of moderate to high intensity (≥ grade 3/6) with maximal intensity over the mitral area, have echocardiographic evidence of advanced MMVD defined as characteristic valvular lesions of the mitral valve apparatus, mitral regurgitation on the colour Doppler echocardiogram, and have echocardiographic evidence of left atrial and left ventricular dilatation, defined as a left atrial-to-aortic root ratio ≥ 1.6 and body weight normalized left ventricular internal diameter in diastole ≥ 1.7, in addition to radiographic evidence of cardiomegaly (vertebral heart sum > 10.5)

In fact, the study was terminated early following an interim analysis as the evidence was considered conclusive and it was deemed unethical to continue to withhold treatment from the placebo group.

Adrian Boswood, Professor of Veterinary Cardiology at the RVC (pictured above right), led the research. He said: "Thanks to the EPIC study results, vets no longer have to adopt a 'watch and wait' approach to suspected preclinical cases of MVD. When a typical mitral valve murmur is detected, vets should now investigate further to look for cardiac enlargement. If demonstrated, this suggests the patient will probably benefit from treatment with pimobendan before the onset of clinical signs.

"It's great that as a trusted treatment, pimobendan has a wealth of safety data behind it in addition to that gleaned from the EPIC study, which can help support vets when prescribing it in this new way."

Adrian added: "As far as evidence-based medicine goes, this is about as good as it gets. The size and design of the study places it in the top-tier. The study was designed and run by an independent team of investigators and sponsored by Boehringer Ingelheim. We, as lead investigators, had the right to publish the results regardless of the outcome. This makes EPIC very special indeed."

In light of the findings, Adrian says vets should now consider testing early for signs of preclinical MVD, and in dogs with cardiomegaly secondary to preclinical MVD, consider the use of pimobendan to delay the onset of congestive heart failure and extend the asymptomatic period.

To read more about the EPIC study and results, visit www.rvc.ac.uk 

Reference

1. Boswood, A., Haggstrom, J., Gordon, S. G., et al (2016) Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study—A Randomized Clinical Trial. Journal of Veterinary Internal Medicine [online]. Available at http://onlinelibrary.wiley.com/doi/10.1111/jvim.14586/full [Accessed 28th September 2016]

Ivan Crotaz MRCVS and Jo Hinde RVN have launched a specialist rabbit CPD company, LagoLearn, to help veterinary surgeons and nurses develop their skills so they can treat pet rabbits to the same level as cats and dogs.

According to the Pet Food Manufacturers Association, there are an estimated 1M pet rabbits in the UK. They are commonly presented for treatment in practice and clients are beginning to expect complex workups and high levels of veterinary care.

Ivan, who qualified from the RVC in 1999, has been taking on first and second opinion rabbit cases for over 12 years and was instrumental in developing the v-gel anaesthetic device for rabbits and other species (www.docsinnovent.com). Jo has worked in first opinion practice since 2007 and was the Blue Cross Veterinary Nurse of the Year in 2014. Asides from her nursing experience, Jo has been teaching rabbit husbandry and nursing to owners and nurses directly and also via the Rabbit Welfare Association since 2012. Jo and Ivan have also taught rabbit anaesthesia at the Western Veterinary Conference in the USA for the last 3 years as well as lecturing for the Rabbit Welfare Association in the UK. 

Ivan said: "We’re trying to get rabbit medicine to be seen as an important CPD subject for vets and nurses. We’re going to be offering day courses and conferences with an enjoyable and challenging mix of small group teaching, problem solving, practical teaching and conventional lectures - making sure that all our courses offer a really enjoyable day out as well as being first class CPD. Our first course is on the 13th October in Berkshire and we’ll be offering many more courses and conferences in the future!"

For more information about LagoLearn and its rabbit CPD, visit: http://www.lagolearn.com 

The RCVS Disciplinary Committee has reprimanded Rahul Shah, a Slough veterinary surgeon, for misconduct after finding him guilty on all three charges of failing to provide adequate care for a dog in his care.

During the four-day hearing, the Committee heard evidence in respect of three separate heads of charge brought against Mr Shah following a castration operation conducted on Shadow, a six-year old Newfoundland dog, which took place on 20 June 2014.

The three charges were as follows:

• That on 20 June 2014, Mr Shah discharged Shadow from his surgery into the care of his owner, Gemma Ballantyne, when Shadow was not in a fit state to be so discharged.
• That, having been alerted in a telephone call to concerns about Shadow’s condition later that evening after he had been brought home, Mr Shah failed to advise Gemma Ballantyne that Shadow should receive veterinary attention as a matter of urgency. Mr Shah accepted in his evidence that he did not give this advice to Gemma Ballantyne, and therefore the issue for the Committee was whether he should have done.
• That, during that telephone call, Mr Shah also failed to ensure that Gemma Ballantyne was fully informed as to out-of-hours care for Shadow.

There was no complaint made as to the undertaking of the operation itself, and the Committee followed the advice from the Legal Assessor that each charge should be considered separately. When making its decision, the Committee did not take into account the fact that Shadow had died as it is impossible to say whether he would have survived had Mr Shah acted differently.

The Committee found each of the allegations against Mr Shah proved. In respect of the first charge the Committee heard from two expert witnesses, Professor Williams and Mr Plumley, who agreed that the decision to discharge Shadow at about 6pm on 20 June 2014, given his condition, was inappropriate.

The Committee considers that discharging Shadow at that time into the care of the owner given his state on discharge, was grossly negligent and a serious error of judgement. It therefore found Mr Shah to be guilty of the first charge.

The Committee then considered that, after being alerted to Shadow’s continued lack of progress by the telephone call from Gemma Ballantyne between 30 and 45 minutes after discharge, Mr Shah exacerbated the situation by the inadequacy of his response in dealing with the concerns raised which, in the Committee’s view, represented a continuation of his previous poor judgement.

The Committee considered that Mr Shah was under a duty of care to advise Gemma Ballantyne to seek urgent veterinary attention for Shadow and by his own admission he failed to do so, and he was therefore found guilty of the second charge.

During that telephone call Mr Shah also gave no further details about the out-of-hours care available to Gemma Ballantyne other than to inform her that there would be an additional cost.

He did not seek confirmation that any such information been supplied by his colleague, Emma Martin (who at the relevant time was a student nurse), however, and at no time did he see Gemma Ballantyne in possession of the discharge sheet. The Committee therefore found Mr Shah guilty of this final head of charge.

The Committee did accept that there was no element of dishonesty, nor was there an aim of financial gain in the case. The Committee also considered that Mr Shah was acting in good faith at all times. It also accepted that Mr Shah was entitled to assume that normal practice had been followed and that a previously compiled discharge sheet, containing the number of the out-of-hours provider, had been supplied to Miss Ballantyne.

Ian Green, chairing the Committee and speaking on its behalf, said: "Balancing all of the factors as the Committee must, it is clear that on this occasion Mr Shah’s conduct fell far short of that which is expected and it therefore finds he conducted himself disgracefully in a professional respect."

Mr Green added: "In imposing the sanction of a reprimand, the Committee urges Mr Shah in the strongest possible terms to ensure that his future conduct by way of training and support systems within his practice are such as to avoid any possibility of a future incident such as this occurring in order to ensure animal welfare and public confidence in the veterinary profession. The Committee notes that in her evidence, Emma Martin said that the working practices at the surgery have been changed and the Committee expects that all animals kept in the care of Mr Shah are fully monitored, examined and assessed in relation to their condition before being discharged."

Following the expiry of Merial's UK patent on the fipronil/S-methoprene combination used in Frontline Combo comes the launch of Amflee Combo, the first generic alternative.

Amflee Combo, a POM, is being launched by a newcomer to the UK market, a Slovenian company called Krka (pronounced kirka). The company says it plans to introduce a vast range of small and production animal products onto the UK market in the next few years. 

Killian Gaffney, Head of sales and marketing at Krka, says the company intends to support UK veterinary surgeons by offering high quality products and by building business relationships that will help protect veterinary incomes, at the same time as offering good value to their customers.

Killian said: "Amflee Combo has some unique features that we believe will set it apart from the competition. We know the combination of the two active ingredients in Amflee Combo is very effective for the treatment of fleas, ticks and biting lice and as part of a treatment strategy for flea allergy dermatitis in dogs and cats. S-methoprene is also effective against flea eggs and larvae in the environment.

"However, these ingredients can be susceptible to degradation when subjected to light and moisture, which is why each Amflee Combo pipette comes in its own special foil wrapper. The pipettes have also been designed for convenience of use, since we know that only 22% of owners apply spot-ons correctly¹."

A range of product and client literature to support the use of Amflee Combo is available by calling 01753 722 150.

Amflee Combo is available in a variety of packs for cats and different sized dogs, containing either three or six pipettes. The recommended treatment is one pipette every four weeks.

Further information about Amflee Combo or Krka is available at www.krka.co.uk

Reference

1. 1 El veterinario ante el cambio climatico Argos 107, 2010.

The French veterinary laboratory TVM has announced that it has acquired Forum Animal Health, the Redhill-based supplier of veterinary pharmaceuticals and animal health products.

TVM, which has a wide range of products in ophthalmology, neurology, geriatrics, gastroenterology, anti-poison management and health and wellness, says that the acquisition is designed to boost the company's international scope, building market share and expanding its leadership in the fields of ophthalmology and neurology beyond France.

The acquisition will also strengthen TVM’s position in the area of animal anti-poison treatment as Forum Animal Health already supplies a canine emetic which it has been marketing in the UK for three years with an awareness campaign about the dangers of toxic products to dogs. This, the company says, has contributed to a significant increase in early interventions by veterinary surgeons in cases of poisoning. A similar campaign is currently being led in France by the TVM laboratory.

To accompany the change, Forum Animal Health is adopting a new visual identity, shown above right.

Blue Cross has announced that in this year's National Equine Health Survey (NEHS), 38% of horses were recorded as suffering health problems and of these 32.9% were categorised as lame.

Consistent with previous surveys, lameness was shown to be more likely to be caused by conditions such as osteoarthritis in the limb rather than problems in the foot.

Blue Cross carries out NEHS in May each year in partnership with the British Equine Veterinary Association (BEVA). It is sponsored by Dodson & Horrell and Zoetis and supported by the UK’s leading equestrian organisations and charities.

This year saw a 14% increase in participation compared to 2015, with survey records returned for almost 16,751 horses, ponies, donkeys and mules and 5635 people taking part. Most horses were kept in livery or a private yard and used for leisure and hacking.

Lameness has been consistently seen as the most common syndrome affecting horses in the NEHS results year on year. In the latest survey a total of 32.9% (24.4% in 2015) of horses and ponies with health problems were recorded as lame. Overall, as in previous years, lameness in the limb was more common than lameness caused by problems in the foot.

A breakdown of the types of lameness revealed that 47.4% were recorded as suffering from proximal limb lameness, 31.9% from causes of foot lameness other than laminitis and 20.7% from laminitis. Degenerative joint disease (including foot and proximal limb) was the most frequently reported single cause of lameness (41.2% of all lameness) and the most frequently reported joint affected by DJD was the hock (15.3% of all lameness).

Reports of foot lameness (excluding laminitis) more than doubled this year at 10.5% (4.5% in 2015) of all syndromes reported with pus in the foot being the most frequently recorded problem. This could possibly be attributed to the persistent wet weather during and prior to the survey, which can increase susceptibility to the condition.

Josh Slater from the Royal Veterinary College, who is a member of BEVA’s Health & Medicines Committee and analysed the NEHS data, said: "The data gleaned from the survey remains consistent year on year, confirming the reliability of our findings for benchmarking, referencing and research. This year’s increase in overall lameness may be in part attributed to the higher incidence of pus in the foot but may also be because owners are becoming more aware of lameness issues. Ongoing research on lameness has generated significant media coverage over the past year, helping to raise understanding of the importance of accurate diagnosis and treatment both from welfare and performance perspectives."

The six most notable disease syndromes identified in the 2016 National Equine Health Survey are:

1. Lameness 32.9% including laminitis (compared to 24.4% in 2015, 21% in 2014, 19.2% in 2013 and 12.9% in 2010-12).
2. Skin diseases (sweet itch, mud fever, rainscald, external parasites, skin tumours and wounds) 25.5% compared to 17.2% in 2015 (18.3% in 2014, 14.6% in 2013 and 15.2% in 2010-12).
3. Laminitis 6.8% compared to 6.4% in 2015 (7.1% in 2014, 4.4% in 2013 and 3.6% in 2010-12).
4. PPID (‘Equine Cushing’s Disease) 6.6%. This is similar to the high prevalence of PPID reported in 2015 (6.4%) and 2014 (5.6%) and possibly reflects increased surveillance through sponsored testing programmes as opposed to true increases in prevalence from the pre-2014 surveys. 
5. Recurrent Airway Obstruction 5.6% compared to 6.7% in 2015 (6.9% in 2014, 4.2% in 2013 and 3.6% in 2010-12).
6. Back problems 5.5% compared to 7% in 2015 (7.7% in 2014, 5% in 2013 and 3% in 2010-12).

Gemma Taylor, Education Officer at Blue Cross said: "The significant increase in participation again this year shows that owners and keepers of horses are really getting behind the survey and recognising its importance in safeguarding the future health and of the UK’s horses. Over the past year NEHS data has been referred to in leading equestrian and veterinary media, showing its credibility as a valuable benchmarking reference."

The 2016 NEHS survey results are now available. To download a copy visit http://www.bluecross.org.uk/nehs2016results  and to register for next year’s survey please visit www.bluecross.org.uk/nehs

VetCompass, a new veterinary research initiative at the Royal Veterinary College, has revealed that one in 60 Cavaliers are affected by syringomyelia.

The RVC says that until now, there has been little reliable evidence on the frequency and severity of syringomyelia in the overall dog population, which has limited veterinary surgeons’ ability to diagnose and manage the condition.

It's not just syringomyelia for which there is a lack of data. Scientists have for years struggled to identify the true extent and severity of diseases seen in the wider general dog population because the main source of veterinary health data on dogs has come from universities and referral hospitals.

While this referral data is useful, the types of animals and conditions that are referred to these referral centres is unrepresentative of the wider dog population, making it very difficult to extrapolate any findings to the general population. The vast majority of animals are managed perfectly well by the primary vet practitioners without ever being referred or even being ill at any one time. 

However, through VetCompass, the RVC is now collecting anonymised clinical data from first opinion veterinary clinics across the UK; data which is being analysed to answer a wide variety of previously unanswerable health questions. 

The VetCompass syringomyelia study published in the Veterinary Record is a case in point. It highlights for the first time the frequency and severity of syringomyelia seen in general practice in the UK.

At an overall dog population level, syringomyelia is not that common, affecting just one in 2,000 dogs. But among Cavaliers, the frequency of syringomyelia is much higher, affecting one in every 60 of the breed. VetCompass data reveals that almost 2,000 Cavaliers suffer from clinical syringomyelia in the UK at any one time. 

Syringomyelia is a severe condition for affected dogs, with the VetCompass study showing that 72% of affected dogs were recorded as showing pain. The study showed that these dogs would often yelp or scream when they were picked up or when their necks were touched. Many of them also showed ‘phantom scratching’ where they would try to scratch at their necks with their hindlegs but without ever even making contact with the skin. Some people refer to this action as ‘playing an air guitar’.  

The RVC is urging veterinary surgeons and owners alike to be aware of the symptoms of syringomyelia, so that clinically affected dogs can be recognised and treated earlier and better. Symptoms include:

• Sensitivity around the head and neck area
• Sleeping with the head raised
• Scratching or pawing the head or neck region
• Weak limbs
• Deafness

Dr Dan O’Neill, Companion Animal Epidemiologist at the RVC, said: "I loved being a first opinion practice vet for over 20 years where I could help animals on a one-by-one basis. But now, with VetCompass, we can help animals by their thousands. An example is this syringomyelia study which may lead to many affected dogs getting treatment much earlier and therefore making their lives so much better."

Professor Holger Volk, Professor of Veterinary Neurology and Neurosurgery, said: “These VetCompass data are an eye-opener; we very frequently see Cavaliers with clinical signs of syringomyelia at RVC’s referral hospital but now we know how common it is in the real world, outside of the referral world."

Dr Ludovic Pelligand, Senior Lecturer in Clinical Pharmacology and Anaesthesia, said: “VetCompass allows us to identify how Cavalier King Charles affected by syringomyelia are treated for pain every day, nationwide. This will help us to understand optimal management and we are currently working on new ways to monitor pain and working towards developing new treatment options to further improve their pain relief and quality of life in the future".

Animalcare has launched the 'Super-earos', described as a unique three-step approach to fighting ear infections in cats and dogs, incorporating a new product designed to maintain healthy ears.

Step 1: Clean with Oticare, a non-irritating, alcohol-free ceruminolytic ear cleaner formulated to keep ears hygienically clean and restore the normal microbiological balance of the ear canal. The product contains soothing essential oils and propylene glycol to moisturise the lining of the ear canal. It also contains a low concentration of lactic acid and salicylic acid.

Step 2: Treat with Aurimic (polymyxin B, miconazole and prednisolone acetate), which tackles the most common causes of otitis externa; e.g. Staphylococcus spp. and Malassezia. Animalcare says the proven synergistic effects of polymyxin B and miconazole¹ allow the reduction of antibiotic concentration and help to minimise the probability of resistance.

Step 3: Prevent with new Oticurant, which Animalcare says is a completely new concept for maintaining healthy ears. Oticurant contains lactic acid to lower the pH, kaolin and lactose to absorb any additional moisture, and special sugars to prevent bacterial adherence to the skin in the ear canal. Oticurant is presented as an odourless mixture of fine powder in single dose sachets.

Tamsin Day, Veterinary Advisor at Animalcare, said: "This is a unique three step approach which we believe will give veterinary professionals more confidence in treating first line ear problems. The Super-earo’s represent a range of three products that together cover cleaning, treatment and prevention. Pet owners will find them easy to administer which will also help to keep these owners compliant to their treatment schedule."

For more information on the Super-earo’s contact your Animalcare representative or visit www.superearos.com

Reference

1. Pietschmann et al (2009): Synergistic effects of Miconazole and Polymyxin B on microbial pathogens.

A man has been arrested in connection with a series of burglaries at veterinary practices around Elmbridge in Surrey.

The RCVS has extended the nomination period for its three honours in order to encourage more people to make a nomination for those they believe deserve to be recognised for their achievements.

The original deadline for nominations for the three honours (the Queen’s Medal, Golden Jubilee Award and Honorary Associateship) was Friday 16 September – this has now been moved to Friday 21 October 2016.

Chris Tufnell, President of the RCVS, said: "Do you know someone who goes above-and-beyond the call of duty? Whose achievements have had a tangible impact on their profession or the veterinary and animal health and welfare sector at large? Then we would strongly encourage you to nominate them for an RCVS Honour. Those who are successful will receive their award at our Annual General Meeting and Awards Day where their achievements will be described and recognised in front of their peers."

The Queen’s Medal was introduced in 2013 and is the highest honour that the College can bestow upon a veterinary surgeon in recognition of those who have achieved a highly distinguished career and outstanding achievements. Nominations can be made by any Member of the RCVS in respect of another veterinary surgeon.

The Golden Jubilee Award was introduced in 2011 to mark the 50^th anniversary of the first RCVS training course for veterinary nurses and now recognises those nurses who are taking a leadership role within the profession. Nominations can be made by either veterinary nurses or veterinary surgeons in respect of a veterinary nurse.

Finally, nominations can also be made for Honorary Associateship which is eligible for those who, while not veterinary surgeons or nurses, have had a significant impact in the veterinary field. Previous winners have included scientists, farmers, farriers, educationalists and journalists.

Further information about making nominations for each of these awards, including nominations forms, can be found at www.rcvs.org.uk/honours. All awards will be bestowed at RCVS Day 2017 in July next year.

Those with questions about making a nomination can contact Peris Dean, Executive Secretary, on p.dean@rcvs.org.uk

John Lewis Pet Insurance has announced that it will not be charging its customers the £200 penalty introduced by underwriters RSA for non-urgent referrals outside its Preferred Referral Network.

The company said:"The RSA Referral Vet Network has been established to give customers access to a trusted network of vets that provide a high standard of service and value for money. However we do understand that in some cases where the primary vet recommends a referral practice and circumstances dictate that our nearest Network partner is not suitable, we will allow our customers to make a choice without being penalised.

If the treatment in question is covered under the policy, there will be no additional fee charged whether or not they choose to use a Network practice."

Vets For Choice, a group of referral practices campaigning against RSA's Preferred Referral Network, welcomed the news. 

However other brands, such as MoreThan, Tesco and Argos, have proceeded with the penalty.

Clive Elwood, one of the referral practitioners behind Vets For Choice, said: "The big question to ask now is if John Lewis can opt out of the fines why can’t Tesco and Argos?

"John Lewis clearly does not agree with springing extra charges on their customers at the point of need and this seems to be in line with their reputation for better customer service.

"MoreThan, Tesco and Argos customers should rightly ask why they are being treated differently to John Lewis customers."

In a press release, Vets For Choice highlighted RSA's July announcement that it was extending its then 29-practice strong referral network by 24, noting that only weeks later it announced its group operating profit was up 20% to £312 million.

In a robust response, an RSA spokesperson said: "The handful of vets behind Vets for Choice have point blank refused to discuss the real issue with non-emergency referrals - the huge variation in costs being charged to pet owners by some vets and paid for by insurers. Vets for Choice has refused to address this issue with us either directly or indirectly, and their desire remains to have a complete lack of transparency about their costs and charges. We are no longer prepared to duck the issue of cost and the lack of transparency in vets’ charges. This impacts on pet owners and means their cover limits do not go as far as they should.

"Our network partners recognise that for pet insurance to remain affordable, the veterinary and insurance industry needs to work more closely together on behalf of customers. Vets for Choice are happy to discuss any issue but the real one and they continue to knowingly distort the facts. The reality is that we have now had 12,700 referral claims from our Network partners, with only 79 customers choosing to pay the £200 charge to use a non-Network partner – well under one percent of all customers. The reality is there is no huge public outcry. The reality is that we have not seen any rise in complaints. The reality is that is our customers are more than happy to have our Network partners treat their pets, knowing that their cover limits are going further. 

"Vets for Choice also mentioned our 20% rise in Group Operating Profit. The key word here is Group – the fact is the majority of our profit was made from our international markets. Group operating profit bears no relation to how our UK pet insurance business performed and it is disingenuous to link the two. It is also disingenuous to imply that all brands should act in the same way as their business models differ according to the customer segment they wish to attract. As ever, the choice remains with the customer."