The first change has been made to paragraph 1.6 which now advises general practitioners to check whether the vet they are referring a case to is on the RCVS Specialist or Advanced Practitioner list, explaining the difference to the client and what sets them apart from other vets who might be prepared to accept a referral.
Also, practitioners who accept a referral should provide information to the referrer about the experience and status of those likely to be responsible for the case.
The guidance about conflicts of interest in paragraph 1.7 has also been amended such that referring surgeons should tell clients if they are referring their case to a practice owned by the same group.
There is new guidance about how vets and nurses talk about referral practitioners, with the new advice being to focus on accepted terms such as 'RCVS Specialist' and 'RCVS Advanced Practitioner', and avoid more general terms like 'referral surgeon' or 'consultant' to avoid confusion or implying that individuals hold more qualifications than they do.
Lastly, there is new guidance that vets may only use the name 'Specialist' in the name of their practice where there is genuine and meaningful involvement, and oversight, in case management by at least one RCVS specialist in all disciplines where any clinical services are offered under the business name.
https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/referrals-and-second-opinions/
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You say ‘now advises general practitioners to check that the vet they are referring a case to is on the RCVS Specialist or Advanced Practitioner list’ which suggests that cases should be referred to specialists or Aps, where the code actually says ‘whether’ they are on such a list (presumably more so you don’t call them a specialist or ap if they aren’t)
Rob Loxley, sorry, I didn’t mean to imply that, but rather to say that if they are referring to Specialists or APs, then they should check that they are on the list, going on to explain that they should also explain what sets them apart from non-APs and Specialists, thereby making it clear that referrals do not HAVE to be referred to APs and Specialists. But you’re right, ‘whether’ is less open to misinterpretation and I will amend it! Thanks.
Sounds great! But the onus should be on referral practices just as much - many ‘specialist hospitals’ are not fully staffed by Specialist clinicians and even within a hospital I would bet that most people could not name the Specislists from the APs from the ‘practice limited to..’
Most of the new guidance is actually a clarification of previous guidance. Not much has actually changed but it does reinforce and serve as a reminder of the responsibilities of clinicians when referring a case to a colleague. I'm one of those referral clinicians that has been pushing for clearer guidance from the RCVS on the whole referral process. I see too many cases where a pet has had surgery performed by a non-specialist, there have been complications and the client finds their way to me. Most of the time in such a situation the client was never offered any choice for the original referral (it's usually to the GP practice's 'orthopaedic surgeon' -i.e. a peripatetic certificate holder/AP) and they were never made aware that the original surgeon was not a specialist or that a specialist referral was an option. This is wrong and it always has been (there has always been a requirement in the code of professional conduct to make owners aware of available options when referring a case, its just that some vets choose to ignore that requirement). I have absolutely no problem with certificate holders/APs taking referrals but we must be absolutely transparent with owners, especially these days with so much attention on the profession. It's the owner's pet and their money -they should be able to choose who treats their dog and where that treatment takes place in full knowedge of the level of expertise available to them. I agree that the requirement of the referring vet to make the owner aware of the level of expertise likely to be available at a particular referral centre is a bit clunky, but it should be easy to find out if a centre is staffed only by non-specialists, or by specialists and non-specialists (e.g. residents) or only by specialists. I do think it's really important to avoid vague titles such as 'Consultant' or 'Referral Surgeon' -these provide no indication of a clinician's expertise or experience but owners are understandably going to assume that such a person is highly qualified, which they may not be. The conflict of interest statement is also not new and (in my opinion) is really important. This would not only apply to a referral to a referral centre in the same group, but also a referral to a peripatetic certificate holder/AP where the host practice keeps a substantial chunk of the referral fees.
Where does this stop though Andy? There is always someone with more qualifications for every procedure. Should I be offering a referral to an ophthalmologist or surgeon (or which) for an enucleation? Or should I be offering and explaining the different surgical qualifications for every pyo, cystotomy, femoral fracture, enterectomy, lump removal procedure that is offered? How competent is competent? If you are an AP and have 300 procedures under your belt should you be making the client aware if you know that another AP 20 miles away has 1000? Does the average GP know how many procedures they have done?
Hi Mark, You raise a very valid question although this is slightly different to that covered by the conversation above. What you are raising relates to the choice of whether to refer or not, not who or where to refer to. The updated guidance is designed to make the referral process as transparent for the owner as possible so that they can make an educated decision on the appropriate level of care for their pet. If a clinician accepts that referral is not necessary for a particular case then that is presumably based on an honest assessment of one's own capabilities and facilities. If it is felt that the outcome for that patient may be better or the risk may be lower elsewhere then I think it's only reasonable that a discussion about referral should be had with the owners. There will be many routine procedures where this is completely unnecessary. What constitutes routine will of course differ between clinicians, hence we all need the self-awareness to make the right choice for the pet.
More on this from the RCVS today:
https://www.rcvs.org.uk/news-and-views/features/standards-and-advice-update-august-2024/?utm_source=informz&utm_medium=email&utm_campaign=rcvs
Andy Moores You heard it here first! (Well, you didn’t, but you know whatimean!)
I dont think this is anything new is it? Its just to say if u need to refer, then refer responsibly and reassure the o that the person who are referring to is competent in that area and is registered as an AP or specialist etc