Petition - Do not authorise prescription of POM-V without physical examination

RE: Petition - Do not authorise prescription of POM-V without physical examination

Iain Richards — Wed, 19 Jun 2019 22:34:37 GMT

Thank-you Ian. I too have been guilty of concern over the commercial sensitivity tweet. My apologes for any misunderstanding. With any number of commercial CPD companies, I can see why this was held in confidence.

I did try to find the full thread and couldn't. Which potentially makes it usining it worse.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Glenn Hodgson — Wed, 19 Jun 2019 20:01:34 GMT

Thanks also for taking the time to reply Ian and Arlo. It is appreciated.

'Fake news' also has no place in such important matters!

Cheers both

[quote user="Ian Holloway"]

[quote user="Glenn Hodgson"]

Here we have a contradiction:

19/06/2019 on Vetsurgeon.org

"RCVS Council discussed this paper ‘in committee’ in order to be able to examine the confidential legal advice it had requested at its previous meeting. The decision to hold these discussions privately was purely related to the privileged nature of legal advice and in no way related to any ‘commercial interests’.

RCVS tweet from 03/06/2019. (Image att).

"it was held in private due to the fact that it involved commercially sensitive information."

[/quote]

No, we don't.

The first quote is taken from our recent response to concerns raised about Council's decision at its June meeting to launch a wide-ranging review of 'under care' and 24/7 cover. This response has already been posted above on this thread, but is also available on our website.

The second quote is taken from a discussion on twitter relating to Council's discussion at its March meeting about outcomes-based CPD. Different meeting and different subject. The article pictured above in the screen grab from twitter was published in the Vet Record on 25 May 2019.

This isn't the first time (or place) I've seen these two discussions conflated, so I'm grateful to have the opportunity to set the record straight here.

Cheers

Ian

[/quote]

RE: Petition - Do not authorise prescription of POM-V without physical examination

Anthony Todd — Wed, 19 Jun 2019 18:56:34 GMT

Don't worry too much. Sooner rather than later there will be a horror story, with photos, death, and probably in the Daily Mail, of a loved pet's demise following a totally inept description of an animal's serious symptoms to a TeleVet service......

RE: Petition - Do not authorise prescription of POM-V without physical examination

Ian Holloway — Wed, 19 Jun 2019 18:08:52 GMT

[quote user="Glenn Hodgson"]

Here we have a contradiction:

19/06/2019 on Vetsurgeon.org

RCVS tweet from 03/06/2019. (Image att).

"it was held in private due to the fact that it involved commercially sensitive information."

[/quote]

No, we don't.

This isn't the first time (or place) I've seen these two discussions conflated, so I'm grateful to have the opportunity to set the record straight here.

Cheers

Ian

RE: Petition - Do not authorise prescription of POM-V without physical examination

Arlo Guthrie — Wed, 19 Jun 2019 17:34:12 GMT

[quote user="Glenn Hodgson"]Here we have a contradiction:[/quote]

Interesting, that. But I'll bet you it's just a bad choice of words. In other words, I think both statements are referring to the legal advice the RCVS got. In other words, it was not a discussion about information from anyone with a commercial interest. But it was legal advice which was commercially sensitive (legal advice about the rights of prescribing online etc is hugely commercially sensitive, obviously!).

In any event, I really do not believe for one split millinanosecond that there was anything dodgy going on. There are people on Council who feel strongly enough about this that there would, I am quite sure, be a whistleblower.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Glenn Hodgson — Wed, 19 Jun 2019 17:21:26 GMT

The below statements are about different topics. Ians reply is spot on.

My apologies, I was duped....

Here we have a contradiction:

19/06/2019 on Vetsurgeon.org

RCVS tweet from 03/06/2019. (Image att).

"it was held in private due to the fact that it involved commercially sensitive information."

RE: Petition - Do not authorise prescription of POM-V without physical examination

Shams Mir — Wed, 19 Jun 2019 15:19:23 GMT

[quote user="Arlo Guthrie"]

I thought that was a bit strong. And is it not a bit unethical to level accusations of being unethical at a colleague in a forum?

Also, in forums I think sometimes people need to start with the presumption that the person you are talking with is not a complete bloody idiot. ie. in this case, it's would be both a reasonable assumption and a professional courtesy to presume that Chris is not sharing confidential information.

[/quote]

As is clear from my post, I put this question to Chris in his capacity as a Councillor, which for the professional purposes is his public position. Now, if the Councillors agree to a meeting being held in confidence behind closed doors, then it should be a legitimate thing to ask why they should be discussing this in the public and if they have sought any clarification of from the RCVS. It was a question about the principle and not about the person. I'm afraid you appear to have taken it out of context and over-reacted. I respect Chris for his stance against remote prescribing and I hope he will continue to vigorously defend the principle of time-bound physical examination before prescription of POM-V.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Bob Russell — Wed, 19 Jun 2019 11:06:44 GMT

Many thanks for your intervention and the clarification.

I do think the IVC issue has become (incorrectly) caught up in the remote prescribing debate.

The remote prescribing side of things has the potential for disaster. Animal welfare could suffer if patients are not actually examined and the economics of general practice could be damaged at a time where a number of practices are already struggling.

The fear is that IVC has become so large and powerful that the independence of the RCVS could be in doubt. At present this is not a concern for me as long as the debate is open and public.

I do have worries about the near monopoly situation that exists in areas and very unhappy that the new IVC owned website does not make it clear that their find a vet link only finds 'their' vets.

Around here there are only two independent practices for miles in a sea of IVC but thankfully it seems we are thriving despite or because of the corporate onslaught. Fair competition is all anyone is asking for.

Not sure anyone questioned the legality or professionalism of the on-line offering from IVC.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Chris Barker — Wed, 19 Jun 2019 10:11:58 GMT

And as a follow up here is a further statement from the RCVS released this morning....

RCVS provide reassurance over recent Council decision to review ‘under care’ and 24/7 cover

We would like to acknowledge and address a number of concerns that have arisen amongst the profession following RCVS Council’s discussion last week that followed up queries raised during the previous debate in November, around the provision of telemedicine services, including remote prescribing.

The RCVS Council decision, made unanimously, was to proceed with a wide-ranging review of RCVS supporting guidance concerning 24-hour emergency cover and the interpretation and application of ‘under veterinary care’, and to postpone the proposed telemedicine trial for the foreseeable future and certainly until the conclusion of this review. The review will encompass, but not be limited to, consideration of what restrictions or safeguards to place on remote prescribing in the form of vet-to-client telemedicine.

RCVS Council discussed this paper ‘in committee’ in order to be able to examine the confidential legal advice it had requested at its previous meeting. The decision to hold these discussions privately was purely related to the privileged nature of legal advice and in no way related to any ‘commercial interests’.

We recognise fully that this is a complex issue, with strong views held on all sides. However, it is entirely right and proper for RCVS Council members to be able to discuss and debate such topics in detail, before reaching a decision through a vote. In the course of such discussions, issues may arise that had not previously been identified, and which may alter the original direction of thinking.

We appreciate that Council’s decision was perhaps unexpected, especially as the original topic had been under consideration for some time. This is why we announced it as soon as possible, along with an indication of what Council would like to happen next.

Whilst it is far too early to have worked out the details of the agreed review, it will be open and inclusive in parallel with our previous consultations, which continue to receive considerable levels of engagement across the veterinary professions and wider industry stakeholders.

We will publish full details about our plans for this review over the coming weeks, and will continue to work hard to engage all veterinary professionals in these important decisions.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Arlo Guthrie — Wed, 19 Jun 2019 09:46:52 GMT

And this just in (you hear it first on VetSurgeon.org, as they say); statement from the RCVS

We will publish full details about our plans for this review over the coming weeks, and will continue to work hard to engage all veterinary professionals in these important decisions.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Glenn Hodgson — Wed, 19 Jun 2019 09:45:26 GMT

[quote user="Chris Barker"]

[quote user="Glenn Hodgson"]

Can you help sooth concerns by explaining why there was a 'confidential meeting'?

[/quote]

That's where you will just have to show a little trust, and I repeat that I am vehemently against remote prescribing.

There were good reasons for the meeting being held in private - I am content that it was absolutely correct to hold it in private - and I am bound by the Council's own code of conduct to respect Council's convention whenever documents are designated as confidential

All I have done is tried to quell the chinese whispers that there was something sinister going on behind closed doors and to flesh out as much as I can the bald statement from the RCVS

And I haven't replied to a private contact from you because I haven't received one!

[/quote]

Again , thanks for putting the effort in. It is appreciated and I clearly understand your stance on remote prescribing.

For the benefit of anyone reading I did not reach out to Chris Braker directly. I reached out to the RCVS.

It is nice to hear that there were good reasons for the meeting to be confidential.

It appears that I am reasonable to probe.

From the Vet Times > "Urgent clarification on RCVS review needed says BVA

BVA “surprised and disappointed” that RCVS makes wide-ranging review of telemedicine and remote prescribing in closed council session without promised stakeholder engagement."

https://www.vettimes.co.uk/news/urgent-clarification-on-rcvs-review-needed-says-bva/

Kind regards and I genuinely appreciate your efforts in what is possibly a busier period for the council.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Arlo Guthrie — Wed, 19 Jun 2019 09:30:12 GMT

[quote user="Chris Barker"][quote user="Shams Mir"]

Is it not unethical for you as Councillor to talk in public about something you discussed in the council behind closed doors [/quote]

I'm afraid you are failing to distinguish personal comments from those made in my role as RCVS Councillor[/quote]

I was going to say ...

Shams Mir I thought that was a bit strong. And is it not a bit unethical to level accusations of being unethical at a colleague in a forum?

RE: Petition - Do not authorise prescription of POM-V without physical examination

Chris Barker — Wed, 19 Jun 2019 09:07:49 GMT

[quote user="Shams Mir"]

Is it not unethical for you as Councillor to talk in public about something you discussed in the council behind closed doors

[/quote]

I'm afraid you are failing to distinguish personal comments from those made in my role as RCVS Councillor

And I'm sorry to disappoint conspiracy theorists, but my comments regarding IVC and its remote service are entirely my own, for there was no discussion of any commercial organisation during the confidential portion of the RCVS Council meeting!

RE: Petition - Do not authorise prescription of POM-V without physical examination

Chris Barker — Wed, 19 Jun 2019 08:30:33 GMT

[quote user="Glenn Hodgson"]

Can you help sooth concerns by explaining why there was a 'confidential meeting'?

[/quote]

That's where you will just have to show a little trust, and I repeat that I am vehemently against remote prescribing.

All I have done is tried to quell the chinese whispers that there was something sinister going on behind closed doors and to flesh out as much as I can the bald statement from the RCVS

And I haven't replied to a private contact from you because I haven't received one!

RE: Petition - Do not authorise prescription of POM-V without physical examination

Shams Mir — Wed, 19 Jun 2019 08:01:52 GMT

Chris Barker

Is it not unethical for you as Councillor to talk in public about something you discussed in the council behind closed doors and must must be signed up to its confidentiality, unless you have run your post through the RCVS first?

Arlo,

I will come back to your points later.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Glenn Hodgson — Tue, 18 Jun 2019 23:33:20 GMT

Thankyou for taking the time.

Can you help sooth concerns by explaining why there was a 'confidential meeting'?

I have reached out directly and am yet awaiting reply.

Kind regards

RE: Petition - Do not authorise prescription of POM-V without physical examination

Chris Barker — Tue, 18 Jun 2019 14:52:02 GMT

Popping my head above the parapet....

As one of those members of RCVS Council who are opposed to the development of those forms of telemedicine which seek to provide remote 'care' (and prescribing) for animals which have never been/cannot be examined, and to proposals which would see cherry-picking by some of the companies keen to bring such services to market, I am pleased that the 'confidential meeting ' at the RCVS means that there will now be a thorough re-examination of our Code of Conduct, of the principle of 'under care', and of our OOH obligations, to ensure that our professional responsibilities apply equally to all those seeking to provide professional veterinary services to the public, and that any anomalies are thoroughly and legally justified. Further development of any plans for a 'trial' of telemedicine will have to await the outcome of this review, and while I cannot predict the outcome, any initiative which seeks to establish consistency of regulation across the whole profession should be seen as a good thing.

And playing devil's advocate...

It cannot be right for a remote telemedicine provider to cherry-pick veterinary work while leaving others (the so-called 'bricks and mortar' practices) to provide both urgent and emergency/OOH care when the animal's needs exceed the care offered down the telephone... And I would expect the proposed review of our Code to set out clearly the basis on which any remote provision professional services can both function and be regulated within the UK.

And while the nascent IVC service (www.myfamilypet.co.uk) may seem a worrying challenge to those practices active in areas of the country where IVC-owned practices predominate, I can see little wrong, legally or professionally, with the service they proposing to offer. For unlike other start-up telemedicine services, when the advice they can offer over the phone is insufficient they have a network of practices to which the pet owner can be referred. They are not offering a stand-alone service with no back-up when an animal's need for hands-on assessment proves essential. Indeed OOH they can either refer to their network of practices, or to a network of OOH centres... (VetsNow)

So in terms of the current Code of Conduct I can see few issues with this new service - provided that they are careful regarding supercession, and are diligent with regard to the acquiring and dissemination of relevant clinical notes, it is an uncomfortable truth that their's may well be a template for future provision. Whether the public will respond keenly to the service I do not know.

But don't blame the RCVS for this. The IVC 'offering' is already compliant with the Code. It is not the result of any telemedicine initiative from the College, it is just a large corporate with many outlets taking the opportunity to exploit their strength in the market. The RCVS has no remit to obstruct such business moves, the service would seem to be entirely legal competition to other practices. The RCVS role is 'simply' to regulate to ensure that animal welfare is properly protected whenever such new systems of delivery are developed.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Bob Russell — Tue, 18 Jun 2019 14:31:31 GMT

Already prepared a complaint to them but it is unclear to me which category it goes into. It does not appear to be broadcast so hopefully goes into the non-broadcast group. Just need to download a screenshot of the page.

Not sure that anything will change as I doubt they give a monkeys.

The reason I will contact the RCVS is because they offer a find a vet service which does include all members of the profession. I believe this link is potentially misleading clients. Unfortunately it covers almost every practice around here.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Evelyn Barbour-Hill — Tue, 18 Jun 2019 11:51:51 GMT

[quote user="Bob Russell"]IVC do not make it clear on their website that the 'find a vet' is restricted to IVC practices. This is misleading and when I get time I will complain initially to the RCVS.[/quote]

Not much point complaining to RCVS, we only have jurisdiction over MsRCVS.

Complain to the Advertising Standards Authority.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Bob Russell — Tue, 18 Jun 2019 11:20:02 GMT

IVC do not make it clear on their website that the 'find a vet' is restricted to IVC practices. This is misleading and when I get time I will complain initially to the RCVS.

'Find a vet in our group' or 'find an IVC practice' also fine.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Arlo Guthrie — Tue, 18 Jun 2019 09:29:02 GMT

[quote user="Shams Mir"]On the other hand, aware of the restrictions posed by the Veterinary Surgeons’ Code of Professional Conduct, UK’s largest veterinary corporate group IVC unveiled its plans for the launching of a nationwide telemedicine programme**.[/quote]

Shams Mir - I am not sure those two facts are related ('aware of the restrictions' and 'unveiled its plans').

I mean, everyone is limbering up to offer telemedicine consultations, and it would be a surprise if they weren't.

My thoughts on all this continue to crystallise.

I agree with you that there are a great many issues and potentially negative consequences of allowing one form of telemedicine, which is the prescribing of POM-Vs to patients or herds you have never seen (ie not under the care of a VS).

But that is only one form of telemedicine. Prescribing POM-Vs to patients who ARE under your care is a very important form of telemedicine which has been going on for years (so far mainly just using the telephone), and which offers time and money-savings for both parties. I think there is an opportunity to expand this form of telemedicine for everyone's benefit.

So what are the big differences between the former and the latter:

Under care means you must have seen the animal within a reasonable time-frame, through which ...
Under care helps maintains the client-vet relationship
Under care means there's accountability tied to a physical presence: a practice
Under care can avoid the problems where a client pays twice (once for an online consultation which tells them they need an offline one!)
Under care (the requirement to actually see an animal) could prevent the formation of a two-tier health system.

I hope you would agree that telemedicine and remote prescribing to patients under the care of a vet with a bricks and mortar presence is therefore a good thing.

Rightly or wrongly, I read a slight implied criticism in your post about IVC starting up its service.

I see no reason to criticise IVC or indeed any other practice from setting up telemedicine services as an extension of their bricks and mortar service.

IVC's service is currently run by one group of vets who, if needed, refer cases to practices within the group. With this structure, I don't think the animals count as 'under care' and therefore cannot be prescribed POM-V medicines. But at least IVC has the infrastructure of practices, so it can offer the physical care and accountability for that care.

I think telemedicine should actually go one step further and be between the individual IVC (for example) VS and their client. That would allow remote prescription within the current rules.

So ... in summary, I would argue:

Telemedicine and remote prescribing etc etc is a GOOD THING when kept in the hands of and tied to bricks and mortar practices.
If you are an independent practice, don't waste time criticising corporates (it would be like criticising a shark for circling). Instead, start looking at remote consulting software yourself, now. You have competitive first mover advantage here (you can remote prescribe to your patients under your care right now, whereas all these other services are waiting for the law to change. And even when it does, you are set up to offer a better, one-to-one level of service).

RE: Petition - Do not authorise prescription of POM-V without physical examination

Shams Mir — Mon, 17 Jun 2019 13:07:49 GMT

Evelyn, I understand your viewpoint and fully agree with you, it is just that I have seen word 'decimate' used quite a lot where it simply means destroying something. Thank you for your considerate response.

RE: Petition - Do not authorise prescription of POM-V without physical examination

Evelyn Barbour-Hill — Mon, 17 Jun 2019 12:07:05 GMT

The trouble with using a word wrongly, even if the misuse has been adopted and perpetuated by journalists and others, is that it detracts from what you are trying to say.

In "decimating the fabric of UK veterinary practice" I see only an irritating mixed metaphor.

If you were to say, for instance, "over small animal practice, I tell you that the corporates now have influence that is incredible" we'd all guess what you meant, but use of the word "incredible" detracts from the force: because if it truly was incredible (impossible to believe) we needn't be so worried. The worrying thing is that it is credible – the evidence is right there before us!

RE: Petition - Do not authorise prescription of POM-V without physical examination

Shams Mir — Mon, 17 Jun 2019 00:47:01 GMT

https://blog.simonsays.ai/decimate-a-common-word-that-many-of-us-misuse-3238f16074f

RE: Petition - Do not authorise prescription of POM-V without physical examination

Evelyn Barbour-Hill — Sun, 16 Jun 2019 20:15:14 GMT

Done.

C'mon folks.

But, er, Shams, "decimating" is not the word you need. I'm not sure I can see how one could decimate a fabric.