Ending remote scripts 'Foolish'

RE: Ending remote scripts 'Foolish'

Alastair Welch — Sat, 05 Sep 2020 14:27:11 GMT

Chris,

Whilst I agree that the changes to the Council Code of Conduct are designed to try and muzzle Councillors I believe that it is still up to each individual as to whether they put the muzzle on.

It is perfectly reasonable to both respect the decision of Council whilst simultaneously publicly disagreeing with and campaigning to change said decision. I have heard the position of College Councillors described as analogous to that of Cabinet ministers insomuch as they are bound by collective responsibility but this argument is erroneous. Cabinet ministers positions are in the gift of the Prime Minister and in accepting the role they sign up to the Government’s agenda. College Councillors are elected directly by the membership and need not feel emasculated by the need to respect the decision of Council.

I am quite sure that it is the paranoid behaviour of the College, seeking to hide as much from the membership as possible and squash any dissenting voices that has led to the recent leaking of information. Rather than waste money on barristers and gumshoes they should seek to understand where they are going wrong which has driven someone to spill the beans.

RE: Ending remote scripts 'Foolish'

Chris Barker — Fri, 04 Sep 2020 19:48:51 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225215#225215"]It is a pity that you didn’t produce a ‘minority report’ at the time rather than toe the line [/quote]

Really didn't seem worth the effort when the BVA representatives were so vehemently against the proposal. And now such a move is virtually forbidden under the Council's Code of Conduct '8. Council members are collectively responsible for the decisions, even if they have voted against, abstained from voting or were absent when the decision was made, and are expected to respect the collective decision.'

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225215#225215"]I fear that we have crossed the rubicon and sadly the pretence of 24/7 care should probably be abandoned. The plethora of limited service providers leaning on those who genuinely provide 24/7 care has become too great to be sustainable and a move to a contract based service to registered clients is inevitable[/quote]

Sadly I agree. I think it is the natural consequence of consumer choice - it seems inevitable that the universal demand for 24/7 will be dropped, but the service will continue to be offered either as a USP by a practice for their registered clients or by those dedicated OOH providers who feel they can run it profitably. The loser will of course be animal welfare and the reputation of the profession, but it is the direct result of obstinacy by the RCVS which has failied to protect those who provide a local OOH service but who are abused by clients of other practices using the Code of Conduct as a threat.

RE: Ending remote scripts 'Foolish'

Alastair Welch — Wed, 02 Sep 2020 16:24:39 GMT

Chris,

It seems as if what you are saying is that at the time of the last inquiry into 24/7 care you disagreed with the conclusions but opted to support it anyway. It is a pity that you didn’t produce a ‘minority report’ at the time rather than toe the line but I imagine that ‘the blob’ kept you quiet.

I did submit a response to the last inquiry but none of my thoughts made it into the conclusions, and I’m not sure whether it’s worth wasting my time again.

I fear that we have crossed the rubicon and sadly the pretence of 24/7 care should probably be abandoned. The plethora of limited service providers leaning on those who genuinely provide 24/7 care has become too great to be sustainable and a move to a contract based service to registered clients is inevitable. The market will provide a solution for many but there will be losers with large swathes of the country (the remote and poor parts) where physically seeing a VS OOH becomes difficult.

RE: Ending remote scripts 'Foolish'

Gillian Mostyn — Wed, 02 Sep 2020 13:41:13 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225181#225181"]Someone else has said it, but I think it is so important to differentiate between this, which is already allowed and has been going on in one form or another for time immemorial, and remote prescribing without having seen the animal in the flesh (or recently enough). If these two very different things get conflated, there is a danger that one of the other may be a casualty![/quote]

David Mills has now explained the situation very well, and I agree with everything he said. However, just to be clear, I really was talking about remote prescribing.

You are correct that we can already prescribe to animals under our care (which, as I've said, is difficult to define and is seen differently in different practices). However, for example, you may have a client whose 3 cats you know, but one you've never seen, but who wants bravecto for all 4. Previously, they would have had to bring the 4th cat in. Now, you can carry out a remote check and dispense for them all. Or a newly-limping but otherwise healthy 6 year old Labrador that you saw for a booster last month. All dispensing of POMS should be preceded by a diagnosis .. so the dog has to be examined first. Remote prescribing allows metacam to be prescribed after a chat with the owner. (And I've found it really useful to be able to do this.) Both those situations are different to prescribing POMS to unknown patients, but before COVID 19 both would previously have been 'illegal'.

However, as I said, it is hard to find a way to legalise the above situations without allowing A N VET to dispense metacam to a dog after an online consultation. In that case, the animals general health is unknown and there will be no follow up or care in the case of drug reaction, failure or worse. So to avoid that situation we're left with the status quo ... No POMs dispensed until after a hands-on examination.

RE: Ending remote scripts 'Foolish'

Mark Holmes — Wed, 02 Sep 2020 13:37:02 GMT

[quote userid="8991" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225207#225207"]Some like it, some hate it. I am a huge fan, for the minor complaints (skin, ears, mild limps, young cat cystitis, CBAs, etc etc) but it takes a certain skill set, and a certain resistance for prescribing 'just in case' such as antibiotics (topicals and oral). It also doesn't sit comfortably with those bleating about 'gold standard' who suddenly now want to cytology all ears, perform a full clinical exam for a CBA etc etc. It doesn't sit well with corporate protocols and full bloods before NSAIDs culture. It does rely on having a bricks and mortar practice to see animals though, as there are limits - e.g. chronic weight loss, ill PUPDs, dysnpoeic animals, major trauma, those that fail to respond to initial treatment. It does rely on knowing the animal, its weight, the client, previous medical history etc. It is far, far, far quicker and more efficieint than seeing patients on site. [/quote]

I think you are correct in that when the client and patient is well known then these conditions can be managed remotely and in those circumstances these conditions can be managed well at the discretion of the Vet. I would not be comfortable with any of these conditions being managed remotely by a Vet unfamiliar with the client and the patient.

The pressure to open up Vets to remote prescribing is not coming from Vets in practice who have generally been quite comfortable with the status quo and often exercise sensible discretion in prescribing. The pressure is coming from those advocating just the sort of "service" or should I say just the sort of "lack of service you" refer to as sole remote prescribing.

As far as I'm concerned far from making the RCVS look foolish it would make the RCVS look like it had a spine and could stand up to lobbying from a rich man trying to get richer!!

As an aside I'm surprised you find it more efficient, most things (particularly the minor conditions described) can be examined in a couple of minutes, far quicker than getting the owner to describe what they think they can see. I gave it up pretty quickly.

RE: Ending remote scripts 'Foolish'

David Mills — Wed, 02 Sep 2020 13:19:02 GMT

There are a few layers to all this, and people are cherry picking facts and applying them to the wrong circumstances.

There is remote consulting (and prescribing). This is providing clinical care without clinical examination, and prescribing medication remote from the animal. It has been going on in some way pre-covid. Farm vets have been doing it for decades without apparent censure or necessarily major clinical issues. It has come in for companion animals in the last few months, linked to registered practices. Some like it, some hate it. I am a huge fan, for the minor complaints (skin, ears, mild limps, young cat cystitis, CBAs, etc etc) but it takes a certain skill set, and a certain resistance for prescribing 'just in case' such as antibiotics (topicals and oral). It also doesn't sit comfortably with those bleating about 'gold standard' who suddenly now want to cytology all ears, perform a full clinical exam for a CBA etc etc. It doesn't sit well with corporate protocols and full bloods before NSAIDs culture. It does rely on having a bricks and mortar practice to see animals though, as there are limits - e.g. chronic weight loss, ill PUPDs, dysnpoeic animals, major trauma, those that fail to respond to initial treatment. It does rely on knowing the animal, its weight, the client, previous medical history etc. It is far, far, far quicker and more efficieint than seeing patients on site.

As an aside, those who are set against it and want the old ways back, a word of caution: with each person you see currently, you risk your hospital or practice effectively being closed through track and trace. Also if two of your members of staff go down with covid, this will trigger a RIDDOR and you had better make sure you were doing everything you could to protect them, or you leave yourself wide open to litigation and HSE investigations, fines etc. This may change with government guidance but simply saying remote consulting doesn't work and everything needs to be seen is like playing with a live grenade, whether that risk is real or not, as an employer it is H&S madness.

There is sole remote prescribing, from providers with no bricks and mortar practice and no relationship with the client. This should be heavily resisted, and it does risk animal welfare without a back up of a practice to see the patient if things don't improve, adverse reactions etc. The idea of an online-only vet is a marketing, profiteering exercise that will harm practices by cherry-picking the easy cases, dispensing at online pharmacy prices, and squeezing profitability of bricks and mortar practices.

There is 'telemedicine' which has gone on for decades, including remote advice and triage. This is normally oral description of symptoms and followed by professional advice. It shares much with remote consulting, without necessarily a structured or systematic history-taking or prescription of medication.

The RCVS need to be clear on the terms of its consultations and the scope of measures being considered. At present, business as usual is being restricted by H&S requirements, so I would expect remote consultation and prescribing to continue for some months, and possibly stay forever. However it should be strictly and permanently linked to a registered veterinary practice, not an online only platform that owners can 'register' with at any time of day. The rules of succession should be an integral part of any remote consulting/prescribing and should be rigidly enforced.

RE: Ending remote scripts 'Foolish'

Arlo Guthrie — Wed, 02 Sep 2020 07:52:09 GMT

[quote userid="4181" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225183#225183"]Is it not an issue of what constitutes 'under my care' and whether that requires a physical examination?[/quote]

Yes, it's just that I've heard a lot of people talk about remote prescribing in the context of an existing practice-client relationship, as though that is part of the issue under debate. It's not, or it shouldn't be, and I think it would be better if the debate about remote prescribing was framed in terms that made this distinction clear at all times.

RE: Ending remote scripts 'Foolish'

Rob Loxley — Wed, 02 Sep 2020 07:40:14 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225181#225181"]I'd suggest that when discussing the issue of remote prescribing as being reviewed by the RCVS, it would be better to use a turn of phrase that conveys the distinction. 'Remote prescribing unseen"?[/quote]

Is it not an issue of what constitutes 'under my care' and whether that requires a physical examination?

RE: Ending remote scripts 'Foolish'

Arlo Guthrie — Wed, 02 Sep 2020 07:31:10 GMT

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225152#225152"]I think remote prescribing could have its place where an animal is currently under care and is known well by the practice, such as with POM antiparasitics and post-op to avoid transporting the pet .[/quote]

Gillian Mostyn Someone else has said it, but I think it is so important to differentiate between this, which is already allowed and has been going on in one form or another for time immemorial, and remote prescribing without having seen the animal in the flesh (or recently enough). If these two very different things get conflated, there is a danger that one of the other may be a casualty!

I'd suggest that when discussing the issue of remote prescribing as being reviewed by the RCVS, it would be better to use a turn of phrase that conveys the distinction. 'Remote prescribing unseen"?

RE: Ending remote scripts 'Foolish'

janine redman — Tue, 01 Sep 2020 22:03:53 GMT

Personally I tried the telemedicine route but nothing replaces actually seeing the patient . Owners misinterpret things and videos only show some things . I reverted to hands on as soon as possible . Quicker , better, safer .

I am more than happy to remote prescribe with those clients and animals I know well. Just as I know which clients can be trusted to follow instructions, which patients will not tolerate particular forms of treatment. I am happy to take responsibility for my own decisions which will always be based on the welfare of my patients and the capabilities of my clients . But I have worked in my current practice for 30 years and know my patients and clients well .

I dislike having to outsource OOH work and we do our own in patient care, but phones go across at 10.00pm. Having worked solidly from 8.00am to 10.30 pm yesterday on bank holiday Monday, I needed that eight hour break to recover enough to face today. However even then I saw an RTA yesterday for the local vets 4 pets as their out of hours was too far for the cat to be transported, And we see holiday makers all the time here in the New Forest , another side to the job

RE: Ending remote scripts 'Foolish'

Ex Member — Tue, 01 Sep 2020 21:37:14 GMT

Hi Kate,

You’re right. Minutes are available to members only, but we take comments and feedback with regards to any aspect of Under Care or 24/7 care from non members (and members) via the email Iain listed.

RE: Ending remote scripts 'Foolish'

Kate Richardson — Tue, 01 Sep 2020 21:11:41 GMT

Iain Richards just to note you can’t read them if you’re not a member, when you click on any of the links to download the minutes you get asked to join the BVA

RE: Ending remote scripts 'Foolish'

Iain Richards — Tue, 01 Sep 2020 16:35:41 GMT

A note that the BVA working group on under care (I'm on it) is approaching it's final meeting. All our deliberations are on the website: https://www.bva.co.uk/about-us/our-structure/working-groups/

The minutes and drafts can be read by members and non members can feed in to ameliaf@bva.co.uk. Please use the subject line Under Care.

RE: Ending remote scripts 'Foolish'

Gillian Mostyn — Tue, 01 Sep 2020 15:14:06 GMT

[quote userid="2235" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225153#225153"]This is how it has always been[/quote]

There is significant variability in practices' approach to antiparasitics. Some will dispense to almost anything, some to registered animals, some to those they've seen within 1 year and I've also come across some where they have a 3 month rule!

RE: Ending remote scripts 'Foolish'

Bob Russell — Tue, 01 Sep 2020 10:53:54 GMT

Does anyone really believe the Royal College will listen? It is not 'modern' nor efficient to cherry pick. It genuinely puts practice viability at risk.

It does appear to be very deaf at the moment!

RE: Ending remote scripts 'Foolish'

Rob Davis — Tue, 01 Sep 2020 09:01:32 GMT

This is how it has always been, there is no need for change.

RE: Ending remote scripts 'Foolish'

Gillian Mostyn — Mon, 31 Aug 2020 08:15:34 GMT

I think remote prescribing could have its place where an animal is currently under care and is known well by the practice, such as with POM antiparasitics and post-op to avoid transporting the pet . Unfortunately there is such a lot of scope for abuse of any regulations by those seeking to make easy money peddling metacam and bravecto I think it would be a mistake to allow it at all.

RE: Ending remote scripts 'Foolish'

Michael Woodhouse — Sun, 30 Aug 2020 18:12:47 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225142#225142"]f you go on holiday you make a similar arrangement.[/quote]

Please, no. I practice in the Yorkshire Dales. Not uncommon to see 4-6 holidaymakers each day. How many come on holiday and don't need a vet? 99%? My phone lines would be blocked solid with everyone temporarily registering pets. You only register as a temporary GP patient if actually ill.

RE: Ending remote scripts 'Foolish'

Rob Loxley — Sun, 30 Aug 2020 13:22:33 GMT

Whatever is being said, it is clear remote consulting and prescribing is being driven by sales revenue rather than animal welfare

RE: Ending remote scripts 'Foolish'

Mark Holmes — Sun, 30 Aug 2020 07:59:59 GMT

I’m glad that the consensus on here is against remote prescribing and I hope that the recent survey of the profession shows that to be the overwhelming opinion.

I consider remote prescribing as a derogation of duty on behalf of the RCVS. Like us they have an oath.

”My constant endeavour will be to ENSURE the health and welfare of the animals committed to my care”

As elected officials it is not a stretch to say that the nation’s animal population is therefore committed to their care and any official is therefore bound by that oath.

In the human medicine remote prescribing may have a greater place. However Doctors have the benefit of being able to converse directly with their patient. I believe remote prescribing isn’t common in paediatric medicine where any assessment goes through a third party.

The subconscious clinical assessment - so important in an examination is totally absent from telemedicine and we are reliant on the quite variable abilities of an owner. Not only to assess OUR patient but then to pass on that assessment to a clinician.

Remote prescribing would be a total derogation of duty and yet another unfortunate step towards deregulation of animal healthcare.

RE: Ending remote scripts 'Foolish'

Alistair Graham-Evans — Sun, 30 Aug 2020 01:50:03 GMT

I think it would be a great educational experience for everyone on the committees making these decisions to spend a few hours one night answering calls at a busy OOH centre.

Some individuals are so far removed from the coal face they wouldn’t recognise a lump of carbon if they tripped over it! If the attrition rate of vets worsens ( and the OOH conundrum contributes to this ) there won’t be much of a profession left to regulate.

When practices register new clients they should be totally transparent about the nature of OOH provision - in the case of mobile vets that may be that they just switch the phone off when convenient and in the case of others it may be that we will direct you to a centre an hour’s drive away. Then the client can decide. Ultimately the responsibility for sourcing care lies with the pet owner.

RE: Ending remote scripts 'Foolish'

Neil Wheadon — Sat, 29 Aug 2020 21:08:14 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225136#225136"]RCVS could easily make it a PSS requirement that OOH provision was within 30 mins of owners registered address (with exclusion for rural areas), based on google maps......[/quote]

Wouldn't it be far easier to simply make it a legal requirement that 'if you have a pet you register with a veterinary practice' If you go on holiday you make a similar arrangement. The RCVS did this with requiring a client to take a pet to an OOH provider that took the pressure off an OOH vet. If you get a living animal as a pet you have a responsibility. People do this with GP's, we should be more forceful and could easily cite 'animal welfare'

Neil

RE: Ending remote scripts 'Foolish'

Gillian Mostyn — Sat, 29 Aug 2020 20:01:12 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225136#225136"]within 30 mins of owners registered address (with exclusion for rural areas),[/quote]

Not workable.

Many clients live some distance away from their preferred practice. It isn't the responsibility of the practice of the OOH provision is in the opposite direction.

Time of day has a massive influence on journey time in urban areas like mine.

Besides which, why would rural areas have an exclusion? If a client is already travelling some distance to get to their vet, then it is even more important that their practice does OOH.

RE: Ending remote scripts 'Foolish'

Michael Woodhouse — Sat, 29 Aug 2020 16:53:22 GMT

[quote userid="5012" url="~/001/nonclinical/f/life-in-practice-discussions/29317/ending-remote-scripts-foolish/225131#225131"]

The only way forward as far as I can see is removal of the requirement to provide 24/7 cover. can't see any other way.

[/quote]

RCVS could easily make it a PSS requirement that OOH provision was within 30 mins of owners registered address (with exclusion for rural areas), based on google maps......

RE: Ending remote scripts 'Foolish'

Clive Ansell — Sat, 29 Aug 2020 12:33:44 GMT

Given that most practices are now corporate (i.e shareholder) owned, and senior management are non veterinary, the RCVS has no jurisdiction any longer.

The only way forward as far as I can see is removal of the requirement to provide 24/7 cover. can't see any other way.