RCVS legislative and disciplinary changes suggestions - Discussion thread

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Rob Loxley — Tue, 09 Jun 2020 18:30:42 GMT

[quote userid="5904" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223341"]If the vet was blameless, surely every employer would protest immediately to the RCVS!?[/quote]

And the KPI for the PIC investigating and then deciding whether to progress a case to the DC is 7-12 months.

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223352"]

Alastair Welch said:
we should not lose sight of the corrosive effects of simply floating these proposals.

I think this is a very important point which is perhaps not given the consideration it deserves (stress perhaps, because I don't really know).

[/quote]

But the RCVS funds Mind Matters, a line of defence against such criticism?

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Arlo Guthrie — Tue, 09 Jun 2020 14:25:22 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223343"] we should not lose sight of the corrosive effects of simply floating these proposals.[/quote]

I think this is a very important point which is perhaps not given the consideration it deserves (stress perhaps, because I don't really know).

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Bob Russell — Tue, 09 Jun 2020 12:45:37 GMT

We are talking about the DC suspending vets pending a hearing are we not?

An employer suspending a staff member is a completely different situation.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

bob lehner — Mon, 08 Jun 2020 21:55:23 GMT

Blimey - no offence taken! And I'm sorry if my response was a bit sharp....

It would be lovely to be able to assess every practice on the clinical ability of each and every vet working there - but let's face it that would be a monumental, if not impossible, task and financially untenable. Furthermore,, who is to say what is 'best practice' in each and every clinical scenario. One only has to read posts on here to see that there are a multitude of varying opinions on something as basic as how to treat a cat bite. I would envisage an unholy row if the authorities tried to force us all to do things in what someone had decreed as 'the proper way'.

The point I was trying to make earlier is that there are a different ways of judging how good a practice is. The client's opinion is obviously a major one, but we all know that clients can have a very unrealistic and ill-informed view of what actually happens in a practice. I well remember years ago doing a locum for an elderly gent. His clients loved him and queues formed down the road every day to see him (no appointments needless to say). In reality the practice was a total disgrace - and the man was an ignorant charlatan, but with an enviable bedside manner. Long before the days of Google - but if it had been there I'm sure he would have had some great reviews.

PSS looks at over 300 different items - which all add up to an overview of how the business runs, whether it is compliant with the multitude of rules and regs from different bodies (whether you like them or not), how it looks after its staff, levels of equipment, care of equipment, hygiene, lab faciliites, in-patient facilities, surgical facilities, radiography, cliniclal governance, medicines, state of the premises, H&S - and a host of other stuff.

These days the assessors are required to engage with a cross section of the practice staff, in order to try and ascertain that things actually happen and it's not just a box-ticking exercise.

Personally, and having visited literally hundreds of practices of all different shapes and sizes, I would tend to think that a practice which performs well at PSS is on balance more likely than not to also provide good clinical outcomes.

Of course you can always find the exception, but I am looking at the broad brush picture.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Alastair Welch — Mon, 08 Jun 2020 21:44:51 GMT

It is hard to know where to start.

Notwithstanding the impact of Covid-19 it is important to view the RCVS' proposed consultations in the appropriate context or 'veterinary landscape':

Prior to Covid I think it is fair to say that we work in a profession which was under some duress. I have heard the profession described as being in 'crisis' and being 'bad for your health', whether or not you believe things are as bad as this I don't think that there are many people describing the UK veterinary profession as being 'rude health'. It would seem that we have developed into an industry which every year takes a cohort of very bright highly motivated school leavers, puts them through 5 years of fairly intense training (and saddles many of them with a large debt) only to provide them with a career which seems remarkably nasty, brutish and short. It is to our shame that I feel compelled to advise any school student who comes to see practice with me to consider an alternative career. The high incidence of mental health issues, substance abuse and suicide within our profession are well documented. It is also important to recognise that that despite the problems which the profession face they continue to provide the general public with an excellent standard of service and surveys continue to report the public's generally very high level of satisfaction and trust in their veterinary surgeon.

Against this background it is reasonable (or at least I think it is reasonable) to expect our regulator to have some insight into the problems that the profession faces (after all we are self regulating so at least in theory our regulators might be expected to understand some of the issues). They should seek to formulate and develop policy which in some way recognises the challenges that the profession faces and dare I suggest offer suggestions which might actually improve the situation.

Instead somewhat remarkably the college seem hell-bent on following a path which is overtly designed to make life as a veterinary surgeon harder and less pleasant. It is shameful and every one of the RCVS council who has MRCVS after their name and does not come out PUBLICLY and condemn the proposals should feel ashamed.

I think we can divide the proposals into two broad categories the 'might well get approval' and the 'unlikely to actually happen'. Fortunately many of the college's really daft proposals fall into the second category; these require primary legislation and in case they hadn't noticed the government have a fairly full plate just now. I have heard it said that changes to veterinary legislation described as the work of a 'third term' administration (All governments eventually run out of good ideas and cast their net wide to fill the Statute book with any old rubbish) but even though in theory the current incumbents have been there for a while, those in the driving seat are relatively new and they will have many other priorities before getting involved with VS. Indeed by the time the government gets round to looking at this it will be time for another review and we can kick the can down the road again. Whilst some of their more outlandish ideas might be seen as unlikely to ever reach the Statute book we should not lose sight of the corrosive effects of simply floating these proposals. The college are sending a message to the profession: ''we are not content with the powers we have, we want to make it easier to get our claws into you and we want to make your life harder'.

There are some changes proposed which can take place without legislation and these do raise cause for concern. The principal amongst these is the change in the standard of proof. It is important to put this proposal in context. Currently the college have a lamentable record in running the disciplinary process. They have set themselves some fairly modest targets in terms of running the process in a timely manner but despite having had years to try and get it right they rarely do. An occasional failing could be excused but this continual poor performance speaks to the lack of effective leadership from the CEO and the Registrar: they seem incapable of running the show but instead of acknowledging their failings and putting their house in order they seek to distract us with these proposals.

Sadly I fear that the proposals (those not requiring legislation) will likely end up being enacted. Too many of the RCVS council and the college staff have invested too much personal capital to pause and recognise the errors they are making, and the harm they are doing.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Anthony Todd — Mon, 08 Jun 2020 16:05:02 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223340"]An employer that sacks someone that is 'innocent' is opening themselves up to legal action for unfair dismissal.[/quote]

Jeez, have we come to legal action as the only way out of a common-sense-and - decency situation!

But then I graduated a long time ago, and really shouldn't be on here.....

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Anthony Todd — Mon, 08 Jun 2020 16:02:25 GMT

[quote userid="3880" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223339"]Who pays the vet during months of suspension?[/quote]

Hold on! Depends on the employer's interview and assessment with the "accused"!

If the vet was blameless, surely every employer would protest immediately to the RCVS!?

I would!!

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Bob Russell — Mon, 08 Jun 2020 15:17:11 GMT

Someone suspended, pending some form of disciplinary action is innocent until proven guilty. An employer that sacks someone that is 'innocent' is opening themselves up to legal action for unfair dismissal.

An innocent vet finding themselves suspended without pay is going to suffer severe financial hardship and is unlikely to be able to work in the meantime.

Most veterinary employers will not be in a financial position to pay someone that is not working, potentially for a considerable time.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Danny Chambers — Mon, 08 Jun 2020 14:54:40 GMT

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223303"]

1. Temporary suspension

Who pays the vet during months of suspension?

Whilst this is fine for other professions - such as the NHS who will continue to pay alasry if suspended - the vet world is a multitude of private enterprises, and given MRCVS status is a condition of most vets' employment, I can't see companies paying a vet who is suspended from the register for months.

Will the RCVS pay them instead?

[/quote]

Totally agree.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Dinu Catilina — Mon, 08 Jun 2020 14:04:09 GMT

[quote userid="6897" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223330"]I'm sorry - but that is such a dumb comment that I can't be bothered to argue with you.[/quote]

I agree with Beats. Seeing practices with very poor performance in terms of practising medicine and passing PSS with flying colours I fail to see what value can PSS bring to any practice other than making sure they comply with regulations.

You should apologise Bob, that was rather unnecessary.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Anthony Todd — Mon, 08 Jun 2020 11:24:39 GMT

[quote userid="12930" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223331"]As a consumer I would, rightly or wrongly, personally place more weight on google reviews on choosing where to take my pet (should I not be a vet) than on an assessment by RCVS PSS.[/quote]

Indeed, me too!

Vets' clients are pretty good [as patients are with doctors and dentists, as I know] rather than some officious box-ticker who can never assess the vet in a consultation and client-assessment or satisfaction situation.

I bet the vet I described who walks out of the consult when a client asks "are you sure?" would pass as fine......

Perhaps someone can explain how and why the PSS is better? I'll bet it relies on the number of bells ands whistles and other obvious things which can be measured and the most unsatisfactory vet will always have.....

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Beats — Mon, 08 Jun 2020 10:50:53 GMT

Sorry, Bob. I didn't mean to offend. I genuinely do suspect this. I may be an idiot as a result and the only vet to think this (my views are undoubtedly not typical of vets and personal to me only).

Say 4.8 or over with 100 reviews or more likely to be a good practice.

Say less than 4.4 with 100 review or over likely to be a less good practice.

As a consumer I would, rightly or wrongly, personally place more weight on google reviews on choosing where to take my pet (should I not be a vet) than on an assessment by RCVS PSS.

EDIT - I realise I didn't give full context to my thoughts and my original post muddied a couple of concepts (perhaps causing offence in the process):

.A GP once handed me a docket to submit a review of him for his re-registration. I appreciate this is not what the RCVS is doing (currently), but this is, to me, re-inventing the wheel less well. Google reviews doesn't just hand out dockets to sound minded clients with no gripe who can write distinguished reviews to box-tick a professional revalidation; anyone can have their say and once one gets a sufficient number of reviews that irons out the statistical chance of outliers quite a bit.

On a separate point, client estimation of good-ness (however collected, but Google Reviews would be the best I'm aware of currently) probably outweighs a scheme such as PSS in terms of identifying best practices. I fully appreciate that this point is highly debatable and my opinion could both be wrong and change with time!

There is a practice near me with 5* Google reviews and I have no reason to doubt that it is outstanding based on this whether in PSS or not.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

bob lehner — Mon, 08 Jun 2020 10:10:50 GMT

[quote userid="12930" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223323"]What we don't need is a rival system to Google Reviews. (Which I suspect currenlty outperforms the PSS for assessing practices accurately in terms of "better-ness".)[/quote]

I'm sorry - but that is such a dumb comment that I can't be bothered to argue with you.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Beats — Mon, 08 Jun 2020 09:37:30 GMT

In the modern world, is suspension needed?

If an employee, then an employer can suspend/terminate an employee who is not up to the task - they don't need the RCVS's help to do this and are likely to be much quicker to do so.

If an employer, then the client-base can make informed decisions for themselves in their own public interest whether they wish to continue pending a hearing of the facts of an isolated incident based solely on a Google Review from the complainer.

If a prospective employee, then references, a chat with the individual and/or a trial period where the individual is observed working would normally suffice?

If more is needed, in an extreme case, then simply publicising that the individual is under investigation should suffice and let employers/clients/employees decide for themselves whether they wish to interact with this indiviudal until the outcome of the RCVS's investigations and deliberations is known?

Perhaps if the RCVS is to act then "supervision" would be more appropriate sanction in such extremem circumstances than "suspension"?

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Beats — Mon, 08 Jun 2020 09:23:18 GMT

How about something wacky like "from a learned vet's perspective":

1. The life expectancy of patients is higher than the national average.

2. The level of patient suffering with pruritic skin conditions and otitis is below the national average.

3. The average lifetime cost per pet is below the national average.

4. The neutering complication rate is below the national average.

5. Enteric commensals surveyed from the patient population show more limited antimicrobial resistance than the national average.

or perhaps, more subjectively:

6. an average vet visiting the practice for a week can tell that it is clearly better than some other practices he/she has visited?

What we don't need is a rival system to Google Reviews. (Which I suspect currenlty outperforms the PSS for assessing practices accurately in terms of "better-ness".)

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Bob Russell — Mon, 08 Jun 2020 09:20:52 GMT

I cannot see how suspension can work because you cannot claim justice where someone is forced to stop work and be without pay before any form of proper judgement has taken place.

Options could include some form of additional insurance to cover income or a full and nearly immediate hearing of the DC in the most extreme cases.

We all deserve the right to a fair hearing with minimal disruption for those affected until judgement has been made.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

bob lehner — Mon, 08 Jun 2020 09:11:04 GMT

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223303"]re is no evidence that PSS practices are better than those which eschew the scheme[/quote]

How are you defining 'better'?

There are so many different ways in which a veterinary practice can be judged. From the client's perspective? From the employees perspective? From the patient's perspective (tho' perhaps that's not readily assessable)? From the regulator's/PI providers' perspective?

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Anthony Todd — Sun, 07 Jun 2020 15:53:03 GMT

[quote userid="2244" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223291"]The innocent should not be punished just in case they might be guilty.[/quote]

Sums it up perfectly!

Mind you I reckon my plumber should be jailed 'cos the tap in the bathroom now leaks badly...... in jest, but gives the flavour!!

[quote userid="9440" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223299"] a hugely expensive case which the client won eventually because he refused to open his front door to the bailiffs at the end of a 2 years case .[/quote]

So why not a simple phone call or visit?? Prior to bleeding months of anguish for the accused vet!!

Come on, most cases are quite simple!

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Anthony Todd — Sun, 07 Jun 2020 15:40:38 GMT

[quote userid="9239" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223308"]Why? We are a different profession that works in a very different way than medical doctors. [/quote]

Er, how, doctors, patients, where's the difference apart from the free NHS.....

Egggaxtely, doctors [people] vets [doctors, vets, and patients, err, animals

[quote userid="9239" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223308"]

Unless the complaint is a lie. What if the evidence will show different in the end?

[/quote]

Because a simple phone call or visit or enquiry to the practice wil confirm or deny the likelihood of proof.

Remember the vet's whole life and career is on the line, so a little bit of investigation at the"prior" stage is only justice.

PS "I think Joe bloggs MRCVS is an obvious alcoholi reeked of alcohol when I saw him for my dog's ingrowing toenail......

[quote userid="9239" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223308"]Unless the complaint is a lie. What if the evidence will show different in the end?[/quote]

Give' em a call at least FIRST!!

That means BEFORE the vet, who may be totally blameless, has to lose sleep, [and promotion, at least, and others being sympathetic and "on your side" for weeks or months!

I remember a case in NZ where a totally blameless head master was wrongly accused of some sort of sexual assault on a pupil. Years later a friend was at a party and the teacher's name came up [innocent totally at tirial] and another party-goer said "mmm. no smoke without fire".............

Yeah, I remember, Joe Bloggs MRCVS was accused of malpractice years ago, thrown out at the hearing but that was 10 months, after the totally unfounded complaint.

Bad things, of any merit or not, always stick!!

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Anthony Todd — Sun, 07 Jun 2020 15:16:16 GMT

Just watched the news iof another famous crime

A talking head said "not enough to prosecute, let alone convict"

Which isn't a bad place to start!

With word changes, [groan] before someone sounds off about crime an' all that etc. etcetc..!

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Dinu Catilina — Sun, 07 Jun 2020 15:02:17 GMT

[quote userid="5904" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223305"]

I think the idea of using another profession or professions would be a very good place to start......

[/quote]

Why? We are a different profession that works in a very different way than medical doctors.

[quote userid="5904" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223305"]

Suspension prior to a "hearing", for vets,seems an easy decision to make in 30minutes I reckon.

eg "stumbling, reeking of alcohol" to take a simple and obvious example.

[/quote]

Unless the complaint is a lie. What if the evidence will show different in the end?

[quote userid="5904" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223305"]

Even easier and simpler,. for suspension prior to hearing would be if "the safety and/or wellbeing of animals could be at risk?"

[/quote]

See above example.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Anthony Todd — Sun, 07 Jun 2020 12:59:15 GMT

What is the procedure and regs. etc for medicos? Usually following, or starting with, a similar and related model is helpful??

Also lawyers and accountants, and I have had some actual experience.

I think the idea of using another profession or professions would be a very good place to start......

Suspension prior to a "hearing", for vets,seems an easy decision to make in 30minutes I reckon.

eg "stumbling, reeking of alcohol" to take a simple and obvious example. The evidence and proof and sanction would follow.

Even easier and simpler,. for suspension prior to hearing would be if "the safety and/or wellbeing of animals could be at risk?"

See above example.

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Julian Earl — Sun, 07 Jun 2020 10:17:58 GMT

Mandatory nosing into practices - there is no evidence that PSS practices are better than those which eschew the scheme. The era of evidence based regulation eh?

I think the first question has to be the primary purpose of the scheme? To enhance the image of practices or dare I suggest, of the RCVS? Or is it to enhance the quality of our work and thereby improve animal welfare? It should p[primarily be the last of these.

That is far from being a simple question if course... Who judges the standard of the practices? . The RCVS can check the tick-boxing aspect by practices applying for the accreditation but surely that is not the true guide to the standards achieved? Who judges the quality of the work done for the animals? I think it must be judged by independent assessment of case outcomes, Probably by case reviewers? Specialists and experts? [ And Who determines their status of The RCVS , no doubt!

As for the original question by David, how do we ensure that a PSS- approval ensures better outcomes are genuinely achieved by a practice? By student selection, appropriate training and effective CPD. What have I missed? Thanks...

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

David Mills — Sun, 07 Jun 2020 09:48:13 GMT

1. Temporary suspension

Who pays the vet during months of suspension?

Will the RCVS pay them instead?

2. Enforced practice standards.

Is this under the commercial enterprise that is PSS? Again, a financial question - are the RCVS going to force practices to pay to be a member of that flawed, bureaucratic cash cow? Or will it be free?

Seems like empire expansion/power grab to me. Greater powers to sanction vets. Lower standard of 'proof' for 'facts' (an oxymoron if ever there was one) will increase work exponentially, the metrics used re DC are a smokescreen and not particularly relevant; there will be more low-level complaints that are taken further because the standard of proof is lower. Suspect this is a diversionary tactic - the RCVS complaints procedure seems, to me, at present unwieldy and poorly managed, with KPIs frequently missed. Increasing this work whilst presenting some vague nod to 'efficiency'. Having people talk about this rather than the RCVS's own performance is useful.

Mandatory nosing into practices - thre is no evidence that PSS practices are better than those which eschew the scheme. The era of evience based regulation eh?

RE: RCVS legislative and disciplinary changes suggestions - Discussion thread

Beats — Sat, 06 Jun 2020 18:28:22 GMT

[quote userid="4181" url="~/001/nonclinical/f/life-in-practice-discussions/29142/rcvs-legislative-and-disciplinary-changes-suggestions---discussion-thread/223300"] I missed in the report what the impact might be of the altered standard of proof onto initial complaints and the number that might proceed to PIC [/quote]

Is the argument that the burden of proof is not an issue in this first stage (the question is whether the charges if proved could amount to professional misconduct); the step of assessing whether the charges could indeed be proven is assessed in the jump between PIC and DC?

I have not read fully the proposals yet, so probably shouldn't comment, but there seems to be a change from case-examiner-group to mini-PIC, then on to PIC. I'm not sure what the significance of this would be with respect to altered standard of proof?

The question that comes to my mind is what is the point of the RCVS disciplinary process (in a self-regulating profession - if it still is to be)? Is it fundamentally a tool aimed at removing members from the club that the club at large is embarrassed of because of their conduct and do not wish to be associated with (in which case I'm not sure how well it performs...)? Or is it to investigate in depth, at huge cost, single incidents (often a dispute regarding less money than the cost of the investigation?) from a position of hindsight as an ultimate arbitrator of complaints for all vets?