The Competitions and Markets Authority (CMA) has announced that it is investigating eight acquisitions by IVC Evidensia.

16 clinics are affected by the investigation, namely Penrose Veterinary Group Limited, Kevin Castle (Pet Care) Ltd, Swayne & Partners Ltd, Treforest Veterinary Clinic Ltd, Mercer & Hughes Limited, Swaffham Veterinary Centre Limited, Anglesey Pet Clinic Ltd, Chiltern Equine Clinic.

It's not the first time, of course, that the CMA has intervened in the veterinary profession.

Earlier this year, it investigated the acquisition of Quality Pet Care (trading as The Vet) by CVS, and then Vet Partners' acquisition of Goddards, which led to CVS selling The Vet and Vet Partners selling eight of the 47 Goddards sites to Linnaeus. 

An IVC spokesperson said: “IVC Evidensia is working closely with the CMA and engaging constructively with this review."

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

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

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

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

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

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

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

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

It was not alleged that Dr Thomason had acted dishonestly.

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

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

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

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/

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

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 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. 

The Veterinary Medicines Directorate has suspended ten drugs for food-producing animals which contain the excipient diethanolamine (DEA), after advice from the Committee for Medicinal Products for Veterinary Use (the scientific advisory committee to the European Medicines Agency) about its carcinogenic risk to humans.

All bar one of the suspended drugs contain the NSAID flunixin. The other affected drug is the antibiotic, Tribrissen:

• Allevinix 50 mg/ml Solution for Injection for Cattle, Pigs and Horses (Ceva Animal Health)

• Cronyxin Injection, 5% w/v Solution for Injection, for cattle and horses (Cross Vetpharm Group Ltd)

• Dugnixon 50 mg/ml Solution for Injection for Cattle, Pigs and Horses (Global Vet Health S.L.)

• Finadyne 50 mg/ml Solution for Injection for cattle, pigs and horses (Intervet UK Ltd)

• Flunixin 50 mg/ml Solution for Injection for Cattle, Horses and Pigs (Norbrook Laboratories Limited)

• Meflosyl 5% Solution for Injection for horses and cattle (Zoetis UK Limited)

• Norixin 5% Solution for Injection for cattle and horses (Norbrook Laboratories Limited)

• Pyroflam 50 mg/ml Solution for Injection for Cattle, Horses and Pigs (Norbrook Laboratories Limited)

• Tribrissen 48% Suspension for Injection for horses, pigs and cattle (Intervet UK Ltd)

The British Equine Veterinary Association says that the decision to suspend the drugs was taken without consultation with the veterinary profession, and is urging the VMD to overturn the suspension in horses not destined for the human food chain, to reduce the potential impact on equine welfare.

Jonathan Pycock, BEVA president said: "BEVA is fully supportive of all attempts to promote food safety, however flunixin is widely viewed as the gold-standard pain killer in horses and is commonly used in horses undergoing both elective and emergency surgery, for the crippling pain associated with laminitis and for severe forms of colic.

"BEVA is calling on the VMD to immediately enable limited batch release of flunixin for use in horses not destined for the human food chain in the interests of animal welfare. The equine veterinary profession has always been open to consultation with the VMD on a range of important matters relating to responsible medicine use, antibiotic resistance, horse identification, passports and the horse meat issue. BEVA is perplexed as to why the VMD failed to consult with the equine veterinary industry on the animal welfare impact of withdrawing such an important drug.”

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.

Dechra Veterinary Products has launched free online Fluid Therapy Calculators to help veterinary staff calculate their patients' fluid requirements.

There are two versions available, small animal and equine. Both are available as an online tool or as a download to your desktop (note that to get hold of the desktop version, you need to try out the online calculator first). 

For small animals, there are three options available. The M1/M2/M3 Plan calculates simple multiplications of the maintenance rate, while the Comprehensive Plan calculates fluid required to provide maintenance requirements, correct dehydration or replace ongoing losses. The third option, the Simple Rate Calculator, is a tool for calculating resuscitation fluid rates and can also be used for large animals. The Equine Plan calculates fluid requirements and infusion rates for both adult horses and foals.  

Dechra says it has launched the calculators as the next component of its Vetivex Fluid support package. Along with the Fluids Knowledge Programme, this initiative aims to help veterinary staff across the UK to deliver effective fluid therapy. 

Larry King, Product Manager at Dechra, said: "The calculators are a quick and easy reference tool for today's busy vet. You simply fill in the body weight and animal type, key in a few details and you have an instant but very accurate fluid rate calculated for you. It saves time and effort and ensures the animal is given the correct amount of fluid. The more effective the fluid therapy regime the faster the animal recovers."

The free Fluid Therapy Calculator is just one of a number of tools Dechra uses to support its Vetivex range of fluids.  There is a range of downloadable reference documents, charts and guides available on the website http://www.fluidtherapy.co.uk/ including the Fluid Knowledge Programme and a full CPD Programme focused on effective fluid therapy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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