The Council of the Royal College of Veterinary Surgeons has unanimously approved the introduction of a disciplinary system for registered veterinary nurses from 1 April 2011.
The RCVS established the non-statutory Register for Veterinary Nurses in 2007, and says that registration signals a commitment from veterinary nurses to account for their professional practice.
Registered Veterinary Nurses (RVNs) commit to keep their skills up to date via mandatory continuing professional development and abide by the Guide to Professional Conduct for Veterinary Nurses. The disciplinary mechanism is the final component of this regulatory framework. From 1 April 2011, an RVN can be removed or suspended from the Register if found guilty of serious professional misconduct, fraudulent registration or criminal offences affecting his or her fitness to practise.
The decision has been awaited for some time, as according to the College, there has been some dispute about whether an RVN could be removed from the statutory List of Veterinary Nurses (meaning veterinary surgeons would be barred from delegating to them tasks allowed under Schedule 3 to the Veterinary Surgeons Act, such as medical treatment or minor surgery), as well as the non-statutory Register.
Following legal advice that it would not be appropriate to remove someone from a statutory list via a non-statutory regulatory system, RCVS Council and the Veterinary Nurses Council opted for removal from the Register only, with the caveat that any such removed VNs will be clearly identified on the List. In addition, veterinary surgeons will be advised, via the Guide to Professional Conduct, against delegating Schedule 3 tasks to them.
Council also confirmed that it would seek an amendment to Schedule 3 as soon as possible, to enable it to remove the names of nurses found guilty of serious professional misconduct or other charges from the List.
VN Council Chairman Liz Branscombe said: "The Veterinary Nurses Council is committed to moving towards statutory regulation for veterinary nurses. This non-statutory commitment to a disciplinary system is our chance to show government and the public that we are ready and willing to be regulated, which should stand us in good stead for the future."
The RVN disciplinary system will mirror that for veterinary surgeons, with the same complaints-handling, investigation and decision-making processes and sanctions.
Registered Veterinary Nurses will receive more detailed information about the system over the coming months.
The Disciplinary Committee has directed that Kfir Segev be restored to the RCVS Register, having removed him over two years ago for dishonesty and misleading clients.
Mr Segev, formerly practising in Stanmore, Middlesex, was removed from the Register following an 11-day hearing ending on 19 May 2009 at which he had been proven guilty of deliberately concealing from his clients that their dog was terminally ill, whilst at the same time recommending that she undergo expensive and unnecessary procedures.
This was Mr Segev’s first application for restoration to the Register. The Committee found that, during his period of removal, he had undergone “extensive personal and professional rehabilitation”, which included attendance at a clinical psychologist and voluntary work in the local community.
The Committee found that, during his period of removal, he had undergone "extensive personal and professional rehabilitation.
From 2009 to September 2011, Mr Segev logged 420 hours of certificated continuing professional development, with particular emphasis on ethics, client relationships and animal welfare.
The Committee noted he had also seen practice and taken the advice of mentors, including about 80 days at “a number of high quality practices with eminent members of the profession”.
These included Professor Dick White MRCVS, of Dick White Referrals, Professor David Noakes FRCVS, Emeritus Professor of the Royal Veterinary College and Mr David Grant MBE FRCVS, Hospital Director at the RSCPA Sir Harold Harmsworth Memorial Hospital, all of whom gave evidence at the hearing in support of Mr Segev.
Professor White said that, since late 2009 when he was approached by Mr Segev for help in remedial training, continuing education and mentoring, he had subsequently had frequent dealings and conversations with him.
Professor White said: “I formed the opinion that he invariably exercised professional clinical judgement that is, if anything, considerably deeper than many professional colleagues. I felt he demonstrated compassion for patients and empathy for owners in equal measure and believed him to have come to understand fully the seriousness of his behaviour."
Mr Segev’s efforts at rehabilitation were described as “exceptional” by Professor Noakes, who said he was “impressed by Mr Segev’s genuine acceptance of the fact that he had committed a serious offence and deserved to be punished.”
Mr Grant, who had been in contact with Mr Segev since November 2010, told the hearing that, in his opinion, it was most evident that Mr Segev accepted his wrongdoing and, along with Professor Noakes, indicated that he was willing to offer continued support and help.
The College opposed the restoration of Mr Segev on three grounds, namely: the gravity of the matters found proved at the original hearing; that the length of time off the Register was insufficient to mark these and ensure that the reputation of the profession was not undermined in the eyes of the public; and, Mr Segev’s conduct, relying on two matters arising from the footage in a BBC Panorama programme, which was filmed both before and after the 2009 hearing.
The College also questioned whether Mr Segev genuinely accepted the original findings.
The Committee agreed that the findings of the original hearing were serious; it was, however, impressed by Mr Segev’s complete and genuine written and public apologies for what he had done.
It disagreed that the length of time off the Register was too short.
It was mindful that the purpose of the sanction of erasure is not primarily of punishment and considered that no useful purpose would be served by delaying further Mr Segev’s restoration.
Whilst the Committee found Mr Segev was wrong to have continued to display ‘veterinary surgeon’ on the practice nameplate (as shown in the television footage), it was satisfied that he did not intend to hold himself out as a practising veterinary surgeon and no harm to the public or animal welfare resulted from his mistake.
The footage also showed Mr Segev was in breach of RCVS guidance on the administration of anaesthesia by permitting a student veterinary nurse to induce anaesthesia by using incremental doses of intravenous propofol, with an unqualified assistant offering advice on the depth of anaesthesia during its incremental induction. The Committee considered Mr Segev’s actions to be an error, now cured.
In conclusion, the Committee accepted Mr Segev “had made genuine and successful attempts to reform his previous attitude and failings”.
It noted that a large number of testimonials had been provided by colleagues, friends and clients, and that the impact of removal on Mr Segev had been severe.
It concluded that his previous mistakes provided “no reason, relevant to animal welfare, to suggest that his restoration would be unwise.”
Speaking on behalf of the Committee, Chairman Beverley Cottrell said: “Restoration to the Register of a veterinary surgeon who has been guilty of disgraceful conduct in a professional respect of such seriousness is not something to be undertaken lightly … But, in all the circumstances of this case, [we have] decided that Mr Segev is a fit person to restore to the Register, and so direct the Registrar.”
The College first became aware that confidential information had been leaked earlier this year after the Veterinary Record made the decision to publish details.
The College says it then provided a number of informal opportunities for the person leaking the information to come forward and discuss the reasons for their actions, but nobody stepped forward.
A Council member then made a formal complaint about the leak, which triggered the complaints policy set out in the College’s Code of Conduct for Council Members and instigated the investigation.
The investigation was run independently of the RCVS by an external specialist consultancy, and coordinated by a legal assessor.
Initially, the investigators were asked to focus on a single leak, but following a number of further leaks over ensuing months, it became necessary to widen the scope and depth of the investigation.
The investigators’ report concluded that there had been several separate and deliberate leaks of confidential information by a current or former Council member over an extended period.
However, they were not able to identify who specifically was responsible for the leaks, and because nobody admitted it, no further action under the complaints policy of the Code of Conduct for Council Members was appropriate.
The investigators concluded that the leaks were not the result of poor understanding of College or Council processes, but a deliberate decision to provide confidential information to third parties.
Council members have therefore agreed to review existing training requirements and mechanisms for handling confidential information and to explore in more detail the potential motivation of the person or people who leaked the information, together with the underlying culture of Council that might have influenced their behaviour.
RCVS President Mandisa Greene, said: “There is no denying this is a sad day for the College, and for RCVS Council in particular. As Council members of our professions’ regulatory body, we must maintain the very highest standards of probity and integrity if we are to maintain the trust and confidence of our professional colleagues. In the same way, we must subject ourselves to the same level of scrutiny and investigation if these values and behaviours are ever called into question.
“That someone chose to breach the trust placed in them by their peers is extremely disappointing, especially when they were given every opportunity to come forward to discuss their concerns, and avoid the College having to launch a formal investigation.
"Our default position during Council meetings is to hold as many discussions as possible in public session to ensure Council’s decisions are as open and transparent as possible – something that we will continue to increase as much as possible. Like any organisation, however, there may be a small number of issues that need to be discussed in closed session – for example, those still at concept stage prior to any decision being made public or put out for consultation, or those containing personal or commercially sensitive data.
"I sincerely hope that all of us on Council can learn from this unfortunate and unnecessary episode. We must rebuild and maintain sufficient confidence in each other, and in our processes, that, even if we disagree on certain matters, it is always best to do so in a direct, upfront and honest manner."
Vet Futures, the joint initiative by the RCVS and BVA to stimulate debate about the future of the profession, has opened a new discussion hospice care, and whether it it will become mainstream in veterinary medicine.
This month's Vet Futures guest blogger, Kath Dyson, a former veterinary surgeon who qualified from Glasgow in 1989, writes that veterinary palliative care, while a relatively recent phenomenon, has been growing in stature, particularly in the United States, with symposia and conferences on the subject as well as webinars and chapters in text books.
She notes the increasing number of UK vets offering hospice care, highlighting the differences between palliative services offered in human and veterinary medicine as well as debates within the profession over the advantages and disadvantages of palliative care versus euthanasia.
She said: "In animal hospice it is the pet's owner who takes on all the financial, practical and emotional costs involved, whereas human patients have a lot more support available. Euthanasia is always an option in veterinary medicine, and indeed euthanasia of an animal can legally be carried out by anyone, so long as it is done humanely."
On the euthanasia debate she adds: "Some regard euthanasia as more of a last resort, with hospice assisted natural death being seen as more preferable and only a minority of patients requiring euthanasia. Others feel that euthanasia is more often likely to be the preferable outcome of a period of hospice care in the animal patient, even though they do not rule out a natural death."
Overall she argues that additional expertise from veterinary surgeons in end of life care will help the profession be "even better able to provide truly lifelong care to all their animal patients".
To accompany Kath Dyson's article, this month's poll asks if hospice care will become a standard part of practice.
Last month's poll asked if vets are given adequate information, guidance and support on ethnic and cultural diversity in relation to a blog written by a British Asian vet about prejudice he encountered from a client. The vast majority (90%) of the 118 people who responded to the poll thought that the profession was lacking in support when it came to diversity. Diversity in the profession and how to increase it has been a key topic identified by the project and it will be one of the issues addressed in the final Vet Futures Report published later this year.
To take part in this month's poll and to read and comment on Kathy Dyson's blog visit www.vetfutures.org.uk/discuss
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 has announced the names of the candidates standing in the Council elections this year and is, once again, inviting veterinary surgeons to put questions to them directly in this year’s 'Quiz the candidates'.
There are eight candidates (well, seven really, if you exclude the 'Donald Trump' candidate) contesting six places in the RCVS Council, including four existing Council members eligible for re-election and four new candidates. They are:
Ballot papers and candidates’ details are due to be posted to all veterinary surgeons eligible to vote during the week commencing 14 March, and all votes must be cast, either online or by post, by 5pm on Friday, 29 April 2016.
To submit a question to the candidates, email it (NB only one per person) to vetvote16@rcvs.org.uk, post it on the College’s Facebook page (www.facebook.com/thercvs) or on twitter using the hashtag #vetvote16, by midday on Monday, 29 February.
Each candidate will then be invited to choose two questions to answer from all those received, and produce a video recording of their answers. All recordings will be published on the RCVS website on Thursday 17 March.
RCVS Chief Executive Nick Stace said: "Last year, all election candidates produced videos for the first time and, with over 3,500 views in total, it seemed a popular way for voters to find out more about the individuals who were standing.
"Providing a way for all vets and vet nurses to put their own questions to the candidates is now an integral part of the elections, and one which we hope will continue to encourage people to get involved and have their say."
Dermot Costello, a Shropshire practitioner, has been suspended by the RCVS Disciplinary Committee for 10 weeks after he admitted being dishonest with a client and falsifying records about the treatment of her dog.
Mr Costello faced four charges against him:
At the outset of the hearing, Mr Costelloe, a partner at a veterinary practice in Market Drayton, Shropshire, admitted all heads of charge against him.
Scruffy had been brought to Mr Costelloe for a consultation on 27 October 2014. He carried out a physical examination and arranged for radiographs and routine blood tests while also prescribing anti-inflammatory tablets for spondylosis. Scruffy was brought back to the practice on 30 October 2014 following the deterioration of her condition. Further assessment took place and an abdominal scan was arranged for the next day. She stayed at the practice overnight, but died at some point during the night of 30 to 31 October 2014.
A telephone call between Mrs Green and Mr Costelloe took place shortly after 8am on 31 October during which he told her that "they had struggled with Scruffy all night" and that, as they were speaking, Scruffy was on oxygen and struggling to breathe.
After Mrs Green said she wanted to come to the practice to be with her dog, Mr Costelloe told her to wait and that he would call her back in two minutes. He did so and told her Scruffy had died five minutes ago, when in fact she had died at some point between 11pm on 30 October and 8am on 31 October.
Mr Costelloe continued the deception at meetings with Mrs Green on 31 October and 19 November 2014 and she was given the falsified clinical records on 4 December 2014. Another meeting took place on 14 January 2015 where Mr Costelloe finally admitted his deception to her. This resulted in Mrs Green submitting a formal complaint to the RCVS on 23 February 2015. He admitted his deception to the College in writing on 4 August 2015.
The Committee decided that all four heads of charge amounted to disgraceful conduct in a professional respect as his actions contravened several sections of the Code of Professional Conduct for Veterinary Surgeons in relation to being open and honest with clients; keeping clear, accurate and detailed clinical records; and not engaging in any actions or behaviour that would likely bring the profession into disrepute or undermine public confidence in the profession.
The Committee noted that, in his statement, Mr Costelloe gave a number of reasons for his conduct, including concern over Mrs Green’s reaction to the death of her dog and concern for the young vet who was on duty when Scruffy died. However, the Committee considered that the need to be open and honest with his clients should have been put above the needs of his practice.
In considering its sanction against Mr Costelloe, the Committee heard mitigating evidence from four character witnesses called on his behalf, as well as a number of written testimonials, and also had regard to his evident remorse, shame and insight into his behaviour.
However, it also considered a number of aggravating factors, including the fact that the misconduct had premeditated elements, was sustained over a period of weeks, and constituted a clear breach of client trust.
The Committee decided that the most appropriate sanction was to suspend Mr Costelloe from the Register for a period of 10 weeks. Chitra Karve, chairing the Committee and speaking on its behalf, said: "It [the Committee] concluded that this was the appropriate and proportionate sanction in this case. The Committee took the view that the likelihood of repetition of dishonest conduct was very low. It had found no ‘attitude of dishonesty’ in the respondent. There were no risks to the welfare or health of animals. The respondent was a good veterinary surgeon and he had shown considerable insight regarding his dishonesty, for example, by actively seeking out Ms Green to tell her the truth.
"The Committee does not condone what the respondent has done. It considers that the public interest requires that there has to be confidence that veterinary surgeons do not fabricate accounts or documents, no matter what their intentions."
She added: "The Committee has therefore determined that suspension for a period of 10 weeks is proportionate in all the circumstances to mark the nature and gravity of the case and is sufficient to maintain public confidence in the profession and to uphold proper standards of conduct and behaviour, and directs the Registrar accordingly."
The Committee’s full findings and decision are available on the RCVS website (www.rcvs.org.uk/disciplinary).
The RVN Disciplinary Committee of the RCVS has removed an Armagh-based nurse from the Register after finding that she'd entered the details of four injections into clinical records when she had no reasonable basis for doing so.
During the four-day hearing, the Committee considered two alternative charges against Ms Tracy Nicholl (nee Wilson) relating to her actions on 3 February 2011, whilst employed by O'Reilly & Fee veterinary surgery, Armagh.
Ms Nicholl was alleged by the College to have administered Dolethal, a pink liquid containing pentabarbitone and used for euthanasia, to a dog called Butch without being directed to do so. It was also alleged that she had made dishonest entries into the dog's clinical records, or had administered drugs without a veterinary surgeon's prescription.
Ms Nicholl was alleged to have administered the Dolethal via a fluid bag and giving set on the morning of 3 February, which she denied. The Committee found that, although a veterinary surgeon believed that she saw pink fluid in the line, uncertainties in the surrounding circumstances made the Committee unable to be sure the line contained pink liquid. Expert and forensic evidence revealed Butch had received Dolethal, but not the route of administration or the timing. Therefore the Committee could not be sure Ms Nicholl administered the Dolethal and dismissed this charge.
However, the Committee found that Ms Nicholl did enter on Butch's clinical records that four drugs had been injected, when she had neither administered them nor been told that the drugs had been administered. Although she denied making the entries in evidence submitted to the hearing, in evidence from an interview with the College on 11 July 2011 she had admitted this and her initials were on the record entries.
The Committee noted these injections would be chargeable, and was satisfied the public would regard making these incorrect entries as dishonest. As Ms Nicholl was a highly experienced, senior nurse who also lectured to veterinary nursing students, the Committee was sure she knew she was acting dishonestly. Further, she had breached her responsibilities to clients by failing to maintain accurate case records, and the entries raised potential animal welfare issues. In mitigation, her actions affected no animal's actual welfare, and there was no evidence that Ms Nicholl had made any financial gain or repeated her conduct.
Ms Judith Webb, chairing and speaking on behalf of the Committee, said: "In addition to the fact that the charge involved dishonesty, there were a number of other aggravating features. The Respondent has not demonstrated any recognition of the seriousness of the record entry allegation, specifically the importance of keeping proper records ... It is in the wider public interest and to protect the reputation of the veterinary nursing profession that the Respondent's name should be removed from the Register."
Ms Nicholl is the first Registered Veterinary Nurse to be struck off since the introduction of the title.
The Royal College of Veterinary Surgeons is inviting comments on new proposals for bringing the Veterinary Surgeons Act 1966 up to date.
In 2005, following earlier consultations, the RCVS Council called for extensive changes in the arrangements for regulating veterinary surgeons and veterinary nurses. Last year, however, the Government made clear that it had no plans to bring forward amending legislation for the time being.
Council has now considered recommendations for more limited changes in the Act. The report of the Veterinary Legislation Group advises focusing on three priority areas: the composition of Council itself; the composition of the Preliminary Investigation and Disciplinary Committees; and the jurisdiction and powers of the two committees.
Council would welcome comments on the recommendations from veterinary surgeons and veterinary nurses, interested bodies and the public.
"We now know that it will not be easy to get any changes to the Veterinary Surgeons Act, so we need to think very carefully about the priorities and how to achieve them," says RCVS President Sandy Trees. "Before making any decisions, we want to hear views from a wide range of people who are affected by the work of the RCVS."
A consultation paper is online at www.rcvs.org.uk/consultations. Hard copies are also available from Jeff Gill, Policy Officer, RCVS, Belgravia House, 62-64 Horseferry Road, London SW1P 2AF, j.gill@rcvs.org.uk, 020 7202 0735. The deadline for responses is 21 October 2009.
The RCVS DC has directed that a Wirral-based veterinary surgeon should be removed from the Register after finding that he had treated clients badly, kept inadequate clinical records, was dishonest in dealing with the RCVS, and that animals in his care were placed at risk.
At the end of the five-day hearing, the Committee found that Ian Beveridge, of the Daryl Veterinary Centre, Heswall, was guilty of charges relating to two separate cases: one concerning a crossbred bitch named Holly, who belonged to Mr and Mrs Flanagan and was treated in February 2011; and the other, a cat called Blu, belonging to Ms Simpson and treated in March 2010.
On the morning of 23 February 2011, Holly was admitted to the Daryl Veterinary Centre in a collapsed state with a swollen abdomen. The Committee found a proper assessment should have led Mr Beveridge to perform an abdominocentesis at the practice, the results of which, in view of the practice and its facilities, would inevitably have led to Holly immediately being referred elsewhere. However, the Committee heard that Mr Beveridge simply placed her on a heat pad for observation until about midday, something it considered no reasonably competent veterinary surgeon in general practice would have done. The Committee also found that, on more than one occasion, Mr Beveridge had refused to discuss referral with Mrs Flanagan, and this amounted to failing to treat her with courtesy and respect as required by the RCVS Guide to Professional Conduct 2010, which applied at that time. Holly was ultimately referred elsewhere and survived. The Committee also found the records of Holly's admission to be completely inadequate.
Blu was presented on 22 March 2010 in a collapsed state by Mr Taylor, Ms Simpson's former partner with whom the cat lived. The Committee found that Mr Taylor was told that the cat would be kept on a heat pad, that no other treatment or diagnosis was discussed, and that the possibility of euthanasia was not raised. Having been unable to contact Mr Beveridge that evening, Ms Simpson went to the practice the following morning, intending that her cat be discharged and taken elsewhere. However, the Committee found, when Mr Beveridge eventually fetched Blu, who had died, he blocked Mrs Simpson's exit from the consulting room, saying words to the effect that had she been a better owner, none of this would have happened.
Mr Beveridge also sent to the College clinical records for Blu detailing a blood sample taken at 19.00 on 22 March, and subcutaneous fluids administered during that night. The Committee found this to contain deliberately false information in order to cast a better light on his management of Blu and that he was dishonest; the document was essentially a fabrication to enhance his own interests.
In reaching its decision, the Committee said that it made allowances for the fact that Mr Beveridge operated in first-opinion practice at a basic level. Notwithstanding this, however, it found him guilty of a very serious failure of care to both patients, which gave rise to serious risks to their safety and welfare.
Professor Peter Lees, chairing and speaking on behalf of the Committee said: "On each occasion [Mr Beveridge] treated the owners with a lack of courtesy and respect and made the difficult and distressing circumstances in which they found themselves much worse than they need have been. The Committee takes a very serious view of his attempt to prevent Ms Simpson leaving the consulting room with Blu, and of the unjust and upsetting way in which he sought to blame her for the animal's death. He showed her no consideration at all. Likewise his refusal to contemplate referral for Holly until compelled by Mrs Flanagan to do so and his persistent refusal to engage with her about this at all was, in the Committee's view, reprehensible."
The Committee directed Mr Beveridge's name should be removed from the Register.
The RCVS has announced the results of the 2016 RCVS Council elections.
Current members Christopher Barker (2,838 votes), Amanda Boag (2,689 votes), Kit Sturgess (2,586 votes) and Stephen May (2,452 votes) were returned to four of the six available seats on RCVS Council. Melissa Donald and Lucie Goodwin are joining Council for the first time with 2,532 votes and 2,307 votes respectively.
The re-election of Stephen May means that he will serve as Junior Vice-President of the RCVS for 2016-17.
Voter turnout was down this year at 15.6% (or 4,403) of those eligible to vote, compared to 18.1% last year and the 17.2% average over the past 10 years.
Eleanor Ferguson, RCVS Acting Registrar, said: "I’d like to congratulate all those who were successfully elected, and re-elected, to Council, and thank all those who took part in this year’s elections – whether by standing as a candidate, casting a vote or submitting questions for the candidates to answer."
The successful candidates will take up their positions at RCVS Day – the College’s Annual General Meeting and Awards Day – on Friday 15 July 2016 at the Royal Institute of British Architects.
Each candidate in the elections was invited to produce a short video in which they answered questions put to them by fellow members of the professions and which appeared on the RCVS YouTube channel. The videos provided by the RCVS Council candidates received 1,169 views while those provided by the VN Council candidates received 779 views.
The elections were run on behalf of the College by Electoral Reform Services.
The new guidance will remove the absolute requirement for veterinary surgeons to perform a physical examination before prescribing POM medicines, making it instead a matter for your professional judgement.
However, the proposed new guidance also imposes a requirement for veterinary surgeons who do NOT physically examine the animal prior to prescribing to provide a 24/7 follow-up service which includes a physical examination.
Furthermore, the new guidance will state that: "Where the veterinary surgeon is not able to provide this service [the physical exam] themselves, they should arrange for another veterinary service provider to do so. This arrangement should be made before veterinary services are offered and confirmed in writing as part of the conditions of service agreed by the client."
This requirement to provide a physical 24/7 follow-up would appear to safeguard animal welfare and protect against the risk of online-only businesses (in the UK or abroad) with lower overheads cherry-picking the job of prescribing medicines.
It should also protect against veterinary surgeons feeling pressured to prescribe inappropriately, because the new, stricter requirements will make it easier for them to decline to do so.
However, the BVA doesn't agree with the new proposals. It feels that remote prescribing should be delivered under the auspices of a Veterinary Client-Patient-Relationship (VCPR), which, according to the American Veterinary Medical Association, requires a physical examination.
BVA President Malcolm Morley, said: “The changes to ‘under care’ guidance are a watershed moment, so it’s positive to see that they have evolved in response to feedback from the profession. New technology presents exciting opportunities to enhance existing veterinary services and has benefits for practices as well as clients and their animals.
"However, BVA has been very clear that we believe remote prescribing can only be safely delivered where a vet-client-patient relationship has been established.
"This is an internationally recognised concept, and we are disappointed that the RCVS has decided not to embrace it.
“Having voted to implement these changes, it is incumbent upon the RCVS and the profession to scrutinise how they play out.
"At BVA we plan to develop advice and resources to support our members and help them comply with the new guidance and realise any benefits of remote veterinary service provision.’
“It is now vital that a timeframe for a review is quickly put in place, so any negative impacts on animal welfare or the sustainability of veterinary services can be dealt with swiftly.”
Council voted by a majority of 20 to 3 in favour of the changes, which it then decided should come into force between 1st June and 23rd December 2023, subject to a review at the next meeting.
Discuss here.
The RCVS is reminding veterinary surgeons and nurses that there is one week left till the deadline for nominations for the 2012 RCVS and RCVS VN Council elections.
Nominations must be made in writing on the prescribed form and received by the RCVS on or before 31 January 2012.
Prospective candidates need to provide the signatures and registered/listed addresses of two proposers, and should also submit a short biography, manifesto and photograph for inclusion in the RCVS News Extra election specials.
Nobody may nominate more than one candidate, and no current member of the RCVS Council or VN Council may make a nomination.
Full details and guidance notes for both elections are available online from the RCVS Council Election page (www.rcvs.org.uk/rcvscouncil12) and VN Council Election page (www.rcvs.org.uk/vncouncil12).
Nomination forms and candidate information forms for RCVS Council may also be requested from Mrs Gabriella Braun (020 7202 0761 or executiveoffice@rcvs.org.uk) and those for VN Council from Mrs Annette Amato (020 7202 0713 or a.amato@rcvs.org.uk).
Six seats on RCVS Council and two on VN Council are due to be filled in the 2012 elections.
Those elected will take their seats on RCVS Day in July, to serve four-year terms, and will be expected to spend at least six to eight days a year attending Council meetings, working parties and subcommittees (a loss-of-earnings allowance is available).
RCVS President, Dr Jerry Davies, has committed to prioritise the establishment of a new Audit and Risk Committee, following publication of the recommendations of a report into two overspends at the College.
Earlier this year, outgoing President Peter Jinman had announced that a review would be carried out into the circumstances that led to higher-than-expected expenditure on the College's new database and building development works in the Lower Ground Floor at Belgravia House.
The RCVS Officer team asked Professor Bill McKelvey - a member of the College's Governance Review Group - and two of the College's Privy Council-appointed Council members to look at all aspects that related to its budgeting and expenditure process of those projects, and propose lessons that should be learned.
Dr Davies said: "That such a review was required is regretted, but I would like to thank Professor McKelvey, Richard Davis and Judith Webb for their diligence in this work. Their recommendations will be a very helpful addition to the work that is currently underway to ensure corporate governance is fit for purpose and, in particular, that the management of capital projects within the College is optimised."
The full Overspend Report (one sentence was redacted on legal advice) was considered by Council at its meeting on 3 November. Council agreed that the recommendations should be made public. The College is currently seeking further legal advice on whether it is proper for the report to be made available under the Freedom of Information Act.
Dr Davies added: "The recommendations of the report are under consideration by a group of five past Presidents, together with Richard Davis and Judith Webb as lay members of Council, under the Chairmanship of Peter Jinman, and their proposals will be considered by Council in due course.
"The recommendation that an Audit and Risk Committee be set up will be prioritised, as this was highlighted as an imperative. Other related activities, such as the development of a protocol for the management of major projects, had already been put in place by Officers prior to the overspend review."
Regarding the two projects at the heart of the report, the College says building work in the Lower Ground Floor at Belgravia House has been complete for some time and the new rooms and their facilities are being used, particularly when Disciplinary Committee hearings render much of the rest of the building out of bounds. The new data management system is also in use and an external consultant is currently looking at the work that has been carried out so far, and will make recommendations for the future.
"Meanwhile, although there are many lessons to be learned from the report, it's business as usual in terms of bringing to a conclusion many of our important ongoing initiatives, such as the introduction of the new Code of Professional Conduct, the consultations on the recommendations of the Specialisation Working Party and a draft Performance Protocol, and, of course, the ongoing work of the Disciplinary and Preliminary Investigation Committees," said Dr Davies.
The recommendations of the report, which were adopted by Council, can be downloaded from www.rcvs.org.uk/McKelvey.
The protesters, which VetSurgeon.org understands comprise six veterinary surgeons and 30-40 pet owners, started their march in Parliament Square and are now bearing down on the RCVS Headquarters in Horseferry Road.
The campaigners are, we are told, protesting against the RCVS position statement on complementary and homeopathic veterinary medicines.
No word yet on how the College proposes to defend itself from the hoard; certainly no sign of any cauldrons of boiling oil atop the battlements, nor any riot police yet in evidence.
More news as it happens. VetSurgeon.org has a photographer on the ground ...UPDATES
1:00pm: The protesters have arrived at Belgravia House. A couple of protesters are armed with umbrellas, presumably to guard against the ever-present risk of overdose. It's getting messy: we're hearing that they've blocked the pavement. Wait up. Someone has emerged from the College to speak with them. Well hello, Mr President.
1:01pm: We were hoping that some of the protesters might, I dunno, handcuff themselves to Belgravia House or something. But after a tense standoff lasting over 36 seconds, it looks like the protest is petering out already. Apparently they've started dispersing to the park opposite.
1:02pm: Yup, they've all gone off to the park now. This may go down as one of the shortest protests in history.
1:16pm: Word has it they've headed off to the White Horse and Bower.More photos of this momentous occasion to follow ...
1. The seasoned campaigner is always careful to choose any banner that appears over their head with great care.
2. It was a beautiful march. A big march. The bigliest. Haven't seen that many people on the street since Donald Trump's inauguration.
3. The RCVS headquarters under siege.
4. Millie the dog (perhaps better called 'Millie the anecdote') illustrates the flawed thinking behind homeopathy.
5. Nobody told this campaigner than homeopathy wasn't banned in the first place. You can get it from any tap.
6. RCVS President, Professor Stephen May, presumably wishing he'd taken the day off work.
7. It took some hours moments before the crowd dispersed fully and life in London was able to return to normal.
3.43pm: The Royal College of Veterinary Surgeons has issued a statement following the march, which says:
The Royal College of Veterinary Surgeons today met a delegation of around 40 animal owners and veterinary surgeons who wished to voice their concern about a recent position statement by RCVS Council on the use of complementary and alternative medicines, including homeopathy.
President Stephen May and CEO Lizzie Lockett received a copy of an online petition that was set up following the statement, which has since received around 15,000 signatures, including around 11,000 from supporters in the UK.
Stephen and Lizzie also took time to hear accounts and stories from the supporters, and to listen to the points they wished to raise.
In view of the cold, wet weather, the College had laid on some hot drinks for all the visitors, and invited the delegation inside, but these were declined.
Stephen said: "We were pleased to be able to meet our visitors today and to receive their petition, although it was a little tricky trying to answer questions on a busy London pavement!
"We continue to recognise that homeopathy and other complementary therapies are popular amongst some animal owners and certain members of the veterinary profession, as indicated by today’s delegation, but it is worth reiterating that the RCVS Council statement does not ban their use.
"What it does state, is that in order to protect animal welfare, we regard such treatments as being complementary, rather than alternative, to treatments for which there is a recognised evidence base or which are based on sound scientific principles.
"This is similar to the position that we have held on complementary therapies for many years, but we will always be happy to receive and consider scientific evidence that demonstrates their efficacy."
I wouldn't hold your breath.
All photographs ©2017 Under licence to London News Pictures Ltd. +44 208 088 1155
The RCVS is looking to recruit two veterinary surgeons as part-time Postgraduate Deans, to help oversee new veterinary graduates during their Professional Development Phase (PDP).
Freda Andrews, RCVS Head of Education said: "The PDP is an online recording system to guide new graduates as they work towards achieving the "year one competences" - the competences expected of a new graduate who's had about a year's experience in practice. Postgraduate Deans monitor PDP participants' progress and respond to their queries, and ultimately sign-off the graduates once their PDP is complete."
The roles have become available as two of the current post-holders, Stephen Ware and Professor David Noakes, wish to hand over to new colleagues. Both Stephen and David have served as Postgraduate Deans since 2007, when the PDP first became a requirement for all new veterinary graduates.
Stephen said: "Being a Postgraduate Dean gives you the opportunity to assist new graduates in the early stages of their career. It is also a way to encourage employers to take a responsible attitude towards new vets, particularly during their first job or two."
Postgraduate Deans are expected to spend up to 20 days a year working mainly online from home, and attend occasional meetings at the RCVS in London. They need experience of general practice, and to be used to dealing with and advising students, or employing and supporting new graduates. A sympathetic understanding of the challenges faced by newly qualified veterinary graduates is also required.
Further information about the role can be found at www.rcvs.org.uk/jobs, and information about the PDP, including a preview, at www.rcvs.org.uk/pdp.
Applicants should send a brief CV, and a covering letter setting out their relevant experience, to education@rcvs.org.uk by 7 March 2011.
Vet Futures has published the results of a survey of the profession in which only half of veterinary surgeons who graduated within the last eight years say their career has matched their expectations.
The online survey gathered views from 892 veterinary students (via the Association of Veterinary Students) and 1,973 veterinary surgeons who had graduated within the last eight years, during May and June this year.
Although 37% of graduates reported that their working lives had met their expectations, and a further 13% said it had exceeded them, this left 50% partly or wholly unsatisfied. Furthermore, 10% said they were considering leaving the profession entirely.
The RCVS and the BVA say the results should be a “wakeup call” to the profession.
Vets who have been qualified for five years or more were least optimistic about the future, rating their opportunities for career progression less positively than more recent graduates. They were also least likely to feel that their degree had prepared them for their current work. Meanwhile, only 34% of students felt that their degree was preparing them ‘very well’ for the work they wanted to do.
73% of students intended to work in the UK, with most aspiring to work in small animal/exotic or mixed practice, although one in 10 was as yet undecided. Of the students, 45% said they wanted to become practice owners or partners. Clearly the reality is proving less enticing, because only 25% graduates shared the same aspiration. In addition, nearly double the number of graduates said they wanted to work outside clinical practice (18%), compared to students.
When looking for a job, the three factors that both graduates and students agreed would have the greatest influence on their choice of career were intellectual satisfaction, location and a supportive environment.
This last requirement chimes with the fact that among the most popular suggestions for improvement to the veterinary degree were compulsory modules on managing stress, personal development and work-life balance, alongside more teaching of business and finance skills, and extra-mural studies (EMS) placements in a wider range of settings, such as industry.
BVA President, John Blackwell, said: “The drop off in career satisfaction for vets during this crucial first eight years in practice is something we can’t afford to ignore. It points to frustration over career development opportunities and dissatisfaction with support available in practice. For the veterinary profession to remain sustainable, and an attractive career choice for the best and brightest, we need to address these issues with some urgency.”
RCVS President, Dr Bradley Viner, said: “We clearly need to address the disconnect between expectation and reality for many recent graduates. Reviewing the educational foundation of the profession is a thread that runs through many of the proposed actions that will be outlined in the Vet Futures report due this autumn. The teaching and assessment of non-clinical skills – both as part of the undergraduate curriculum and within postgraduate education – will be important, as will be the promotion of non-clinical career pathways.”
The survey also covered issues such as students’ aspirations in terms of the type (size, ownership, sector) of practice in which they would like to work, and graduates’ future career plans. It also considers attitudes from both groups with respect to new technology.
The full research report “Voices from the future of the profession,” can be read at www.vetfutures.org.uk/resources.
The Royal College of Veterinary Surgeons is warning veterinary surgeons to be on their guard after it came to light that a fraudster is charging a £150 'non-refundable application fee' for an RCVS 'internship' which does not exist. Apart from anything else, the RCVS does not offer internships.
Information about the fake internship has been sent to individuals registered with German website http://www.vetcontact.com/. It includes details about the Royal Veterinary College and the RCVS, but is basically fiction. It refers to a made up 'RCVS Hospital' in the 'Flint Hills of London'.
Gordon Hockey, RCVS Head of Professional Conduct said: "So far, only a handful of veterinary surgeons - all based overseas - have contacted us regarding the internship and queried the request for a non-refundable 'application' fee, although we are concerned that others may have been caught out.
"We would advise any veterinary surgeon to think twice before paying for a third party to facilitate an application for any placement or internship, and reiterate that the RCVS does not offer any such programmes."
The College is following up the situation with http://www.vetcontact.com/ and, if appropriate, will notify the police. In the meantime, anyone who is concerned that they may have fallen victim to the hoax should contact the RCVS Professional Conduct department on 020 7202 0728.
The RCVS has announced that its current Treasurer, Dr Bradley Viner, will be the College's next Vice-President after he was elected to the post at RCVS Council last Thursday.
Dr Viner has been an elected member of Council since 2005 and Treasurer since 2010 and will take up his latest position at RCVS Day - the College's Annual General Meeting - on 11 July. He replaces Professor Stuart Reid, who Council confirmed as President for 2014-15, and will take up his new role in July.
During his time on Council Dr Viner has served on all of the major committees with the exception of the Disciplinary Committee. Outside of Council he runs a group of practices in North West London and is Vice-Chairman of Battersea Dogs and Cats Home.
In his manifesto he set out the nature of his Vice-Presidency, stating: "My personal ethos is very much based upon continual improvement. It is only by having the confidence to discuss openly how things could have been done better that an organisation can learn how to improve.
"I also recognise the vital importance of good communications: with Council; the profession at large; Government; and with other interested organisations. I intend to do my utmost to communicate with them as effectively as possible."
At the same meeting of RCVS Council, Colonel Neil Smith, the current President, was confirmed as Vice-President from July, subject to his re-election in this year's RCVS Council elections.
In addition, Chris Tufnell was re-elected as Chairman of the Education Committee, while David Catlow was elected Chairman of Standards Committee, also subject to his re-election in this year's RCVS Council elections.
Mr Doherty was convicted, with others (who were also convicted), in a conspiracy to deceive members of the public by passing off puppies that had been bred in puppy farms as being the home-bred offspring of domestic pets living in family homes.
Mr Doherty’s role was that he provided vaccinations and vaccination/health check cards which, the court found, materially contributed to the impression that the puppies had been home-bred locally and were in good health.
Mr Doherty was initially convicted of this offence, resulting in eight months’ imprisonment in April 2018.
However, he subsequently appealed the conviction, which was quashed and resulted in a retrial.
On retrial, Mr Doherty was convicted and sentenced to 24 months’ imprisonment, suspended for 18 months, 150 hours community service and a £100 victim surcharge.
When deciding on the sanction, the Disciplinary Committee considered that a period of suspension would be sufficient to meet the public interest.
In reaching this conclusion, the Committee took into account that Mr Doherty had, as part of his original conviction, already served eight months in prison before the original conviction was quashed and replaced, on retrial, with a suspended sentence.
He had therefore already, in effect, had a period of suspension from practice, which meant that the deterrent factor in a sanction of suspension had been partially met.
In reaching its decision, the Committee also took into account the circumstances of this case and, in particular, the view of the court that Mr Doherty had been motivated solely by animal welfare concerns and not financial gain, and that it was this overriding concern that had allowed others to exploit his willingness to continue to vaccinate puppies despite their source.
There were no concerns as to Mr Doherty’s skill or dedication as a veterinary surgeon and with regard to the single issue of the appropriate vaccination of puppies and their onward sale, the Committee noted the changes that Mr Doherty had made to his practice procedures to avoid any similar problems occurring in the future.
The full decision and findings from the hearing can be found at www.rcvs.org.uk/disciplinary
The RCVS announced in a tweet yesterday afternoon that it will be retaining postnominals on the Register.
#RCVScouncil agrees to retain postnominals on Register. Proposals to improve clarity to come back to future meeting. — RCVS (@RCVS_UK) June 5, 2014
#RCVScouncil agrees to retain postnominals on Register. Proposals to improve clarity to come back to future meeting.
VetSurgeon understands that the proposals to improve clarity may yet involve some rationalisation of the postnominals that will be displayed, but that RCVS Certs and Diplomas will remain.
The decision represents something of a victory for Victoria Lilley’s campaign and yet another indication that under the stewardship of Nick Stace, the RCVS really is evolving to become a more open, responsive organisation.
Ms Hill and Wilfred Wong snatched the child from their foster carer when they arrived home from school on Anglesey.
Hill wrestled the child from the car and put them in a waiting vehicle while Wong held a knife to the foster carer’s throat before slashing one of the carer’s car tyres to stop them following.
Having made their escape, they then transferred the child into the hands of two other conspirators who had hired a car to take the child abroad.
The child was rescued four hours later when the hire car was stopped by police on the M1 in Northamptonshire.
A police investigation later concluded that the child had not been the victim of any abuse.
Ms Hill was sentenced at Caernarfon Crown Court to 19 years, 5 months, with a custodial term of 14 years and five months.
Ms Hill did not attend the RCVS disciplinary hearing as she was serving her prison sentence, and she was not represented.
In relation to the charges, the Committee was presented with the sentencing remarks from Ms Hill’s conviction at Mold Crown Court.
The judge said that Ms Hill had led the conspiracy to kidnap, and that it had caused the victim and the people responsible for their care “unspeakable misery and considerable harm”.
The judge also said that Ms Hill posed a significant risk of causing serious harm in the future.
Dr Hazel Bentall, chairing the Committee and speaking on its behalf, said: “The Committee took into account a number of aggravating features when considering the sanctions.
"In particular, the Committee considered that the conviction arose as a result of careful planning over several months and involved the use of violence.
"The Committee concluded that there were no mitigating factors apart from that Dr Hill had no previous regulatory history and that the only appropriate and proportionate sanction was that Dr Hill’s removal from the Register of veterinary surgeons be maintained.”
Dr Hill has 28 days from being notified of her removal from the Register to lodge an appeal with the Privy Council.
The Committee’s full findings can be viewed at www.rcvs.org.uk/disciplinary
The BVA and RCVS have announced the formation of the Vet Futures Action Group to take forward the ambitions and recommendations in the Vet Futures report ‘Taking charge of our future: A vision for the veterinary profession for 2030’ launched in November 2015.
The call for applications attracted more than 80 candidates with many more expressing an interest in helping to take the project forward.
The Action Group will be tasked with working collectively to turn the report’s 34 recommendations into clear actions with buy-in from across the veterinary profession and a timetable for activity.
The Action Group is made up of the BVA and RCVS Presidents and Junior Vice-Presidents, seven veterinary surgeons, a veterinary nurse, and a co-opted veterinary student:
The members of the Group joining the BVA and RCVS officers were selected by the Vet Futures Project Board for their mix of experience and expertise across the Vet Futures ambitions and themes (Animal health and welfare; Veterinary professionals’ wider roles in society; The health and wellbeing of veterinary professionals; Diverse and rewarding veterinary careers; Sustainable businesses and user-focused services; and Leadership), as well as in veterinary education, veterinary regulation, and veterinary nursing.
BVA President Sean Wensley said: "The Group has a very important task ahead and we are confident that we have an excellent group of people with the right balance of skills, experience and expertise to take forward the Vet Futures recommendations and turn them into concrete actions.
"We have had an incredibly positive response from the profession to the launch of the report and we hope organisations and individuals will now step up to work with the Action Group and take ownership of the activity for the good of the whole profession."
RCVS President Bradley Viner said: "We were overwhelmed by the response from the professions with ten applications for every place, and many more offers of support. The Project Board was particularly impressed by the high quality of the applications and the breadth of experience demonstrated by the candidates from all parts of the profession.
"It was incredibly difficult to select the members of the Group from such a strong field but we are pleased that we have captured the variety within the profession as well as the enthusiasm to drive the project forward. We sincerely hope everyone who expressed an interest will remain engaged with the project as it progresses this year."
A petition to protect the title Veterinary Nurse has received an impressive 1,285 signatures, including many from veterinary surgeons, and an official response from HM Government.
The petition, which was started by VetNurse.co.uk member Nick Shackleton Dip AVN (Surgical) VN on 6th June last year, explained: "The title veterinary nurse at present is not a protected title. A lot of people who work in practice call them selves veterinary nurses, when they have no theoretical training in such a position. As qualified nurses we feel that this issue should be addressed so that the general public are no longer confused as to the qualification and hopefully make them more aware of the hard work it is to gain the qualification. As we are heading for autonomy within the profession I think it is right and fitting that the title should be protected."
The Government response, whilst predictably noncommittal, did at least seem to recognise the issue: "The Royal College of Veterinary Surgeons (RCVS) maintains the Statutory List of veterinary nurses. In order to qualify, nurses must undergo a two-year period of vocational training which is assessed at work and through examination by the RCVS Awarding Body.
On being added to the Statutory List they are entitled to undertake a range of veterinary treatments and procedures on animals under veterinary direction. Only listed nurses are entitled to use the post-nominal letters 'VN'. The RCVS are introducing new arrangements for 'registered' veterinary nurses which provides greater accountability and transparency for those nurses whose names are entered on the register. These arrangements run in parallel with the Statutory List.
Some veterinary practices may employ staff who do not carry out the duties of a veterinary nurse but possibly use that title or wear a uniform which might imply that they are a trained veterinary nurse. We appreciate that there are issues surrounding best practice that the RCVS and the Veterinary Nursing Council to address.
It is generally accepted that the arrangements for regulating veterinary nursing could be modernised. This would, in due course, help provide greater protection for the title of veterinary nurses. Although Defra currently has no plans to undertake a fundamental review of the Veterinary Surgeons Act, we are regularly in touch with the RCVS to better understand its priorities for regulatory reform.
Mr Lomax was found guilty of causing death by careless driving at Shrewsbury Crown Court in July 2019 and was subsequently sentenced to a 12-month community order, 300 hours’ unpaid work, 15-months’ driving disqualification and ordered to pay £1,000 in prosecution costs and victim surcharge of £85.
Mr Lomax declared his conviction to the RCVS in April 2020 as part of his declaration upon renewing his registration, following which the RCVS started its concerns investigation process leading to his appearance before the Disciplinary Committee last Monday.
At the outset of the hearing Mr Lomax admitted the charge against him, which was also accepted by the Committee based on its receipt of the certificate of conviction from Shrewsbury Crown Court.
The Committee then considered whether the conviction rendered Mr Lomax unfit to practise. The RCVS submitted that the nature of the conviction and the devastating consequences of Mr Lomax's conduct, which caused the death of a 64-year-old woman, rendered him unfit to practise.
The College also submitted that his conduct would be considered to have fallen far short of the standard expected of a member of the profession, that it had devastating consequences, and that the conviction would have an impact on the reputation of the profession and the public’s confidence in it.
Mr Lomax’s counsel, who represented him during the hearing, submitted that he did not accept his conduct rendered him unfit to practise as a veterinary surgeon, although Mr Lomax did accept that the impact of his conduct was devastating.
Mr Lomax’s counsel submitted that there was a significant difference between his conduct and its consequences, as evidenced by the fact he was charged with careless driving rather than dangerous driving meaning that, though his standard of driving had fallen below that expected of a competent and careful driver, it did not fall far below. Nor was there a suggestion that Mr Lomax had carried out a deliberate act, was carrying out any dangerous manoeuvres or was otherwise impaired.
Dr Martin Whiting, chairing the Committee and speaking on its behalf, said: “There is no doubt that the consequences of Mr Lomax’s conduct were serious and tragic for the [victim’s] family.
"The Judge at the Crown Court referred to their loss in detail and it no doubt played a significant part in the sentence he passed, as reflected by his comments.
"The Committee was cognisant, however, of the different role it had to perform.
"A criminal conviction marks a breach of criminal law, whereas a finding of unfitness marks a breach of professional standards.
"When looking at the conviction, the Committee focused on the actual conduct of Mr Lomax and the concomitant level of culpability, rather than the consequences. Whilst it would be artificial, insensitive and inappropriate to ignore the consequences, the Committee was concerned with the conduct.”
He added: “The Committee did not consider that Mr Lomax’s conduct was liable to have a seriously detrimental effect on the reputation of the profession and concluded that the public, in full knowledge of the circumstances of this particular case, would not expect a finding that the conviction renders him unfit to practise as a veterinary surgeon.
"Rather, the public would recognise that whilst the consequences were appalling for the [victim’s] family, in terms of Mr Lomax’s culpability this was a momentary piece of poor driving rather than anything more blameworthy. At its height it was careless driving for three or so seconds.
"In the Committee’s view Mr Lomax’s careless behaviour fell below, but not far below, the standard expected of a veterinary surgeon and did not amount to disgraceful conduct in a professional respect.”
The full findings of the Disciplinary Committee can be found at www.rcvs.org.uk/disciplinary