The British Equine Veterinary Association has published a new webinar for equine vets called "Worm control: Sifting through the Sh1t".

The webinar, which is presented by equine internal medicine specialist David Rendle from Rainbow Equine Hospital, challenges some of the current perceptions of worm control in horses and explains why veterinary surgeons need to engage more with horse owners on the topic to ensure a sustainable approach to parasite control. 

Supported by Virbac, maker of Equimax and Eraquell horse wormers, the webinar is free to BEVA members at http://www.ebeva.org/webinar74.

Medivet has announced the opening of a "centre of excellence" in orthopaedics at its referral practice in Faversham, Kent.

The team at the centre will be led by Dr Ryk Botes (pictured right), a Medivet Branch Partner with a special interest in orthopaedics and, in particular, replacement surgery.

The company says it is investing in specialist equipment to help the team refine current surgical techniques, including a gait analysis walkway which will be used to help diagnose the cause of lameness and be a means to measure improvement in surgical cases objectively. The data it provides will also enable the team to publish its results in peer-reviewed papers.  

Ryk, who qualified in South Africa and joined Medivet in 2013, said: "The volume of elbow, hip and knee replacements we undertake is growing rapidly and the creation of this new centre of excellence at Medivet Faversham will enable us to provide an even higher standard of service to our clients and to help develop and refine orthopaedic techniques for use by the wider veterinary community.

"Data from the gait analysis walkway will be particularly useful in sharing our findings in scientific papers. We will also use the data to support an ongoing research project in elbow replacement surgery in partnership with one of the leaders in implant technology based in Zurich, Switzerland.

Chanelle has launched Osteopen (pentosan polysulphate sodium) for the treatment of arthritis and degenerative joint disease in dogs.

Osteopen (pentosan polysulphate sodium) is a semi-synthetic polymer which Chanelle says has anti-inflammatory properties which particularly benefit the cartilage and other components of synovial joints.

The company also says pentosan polysulphate sodium is capable of modifying the metabolism of the joint structures, leading to the production of the lubricating synovial fluid which in turn reduces pain and helps regenerate damaged joint components.

Chanelle advises that normally, a course of four subcutaneous injections is given with 5-7 days between each injection, with beneficial effects normally noticed after the second or third injection and the improvement usually continuing until after the last injection is given. The beneficial effects are usually maintained for a few months after the fourth injection. If some deterioration is noted in future, the course can be repeated, up to three times in a 12 month period. 

Chanelle’s Head of Sales and Marketing Killian Gaffney said: "Osteopen is a very significant product launch for Chanelle to the UK and Irish markets, and the product will be the first alternative pentosan polysulphate sodium available."

He added: "The launch of Osteopen offers choice to the practitioner backed up by a thorough support package featuring vet and owner brochures, posters, pens and notepads."

The RCVS has launched the Edward Jenner Veterinary Leadership Programme, a online leadership training course for all members of the practice team.

The programme, which was developed in collaboration with the NHS Leadership Academy, is designed to teach a number of skills that underpin good leadership, including decision-making, resilience, implementing an inclusive culture and encouraging reflective learning approaches. It comprises two free-to-access courses and an optional paid for assessment.

The College says that one of the programme's most popular aspects is its audio drama, which follows the lives of veterinary professionals living in the fictional county of Glenvern. The stories that depict the characters’ working lives seek to reveal the diverse leadership challenges that veterinary professionals face on a day-to-day basis. This in turn prompts the listener to reflect, consider how they would respond, and learn from their own experiences as well as those of other people.

The first course was piloted this summer, with over 550 veterinary surgeons, veterinary nurses, students and practice managers helping the College to develop and refine the material, whilst a group of learners are currently piloting the second course in the series.

Simon Patchett MRCVS, who works at Vets Now 24/7 Emergency and Specialty Hospital, Glasgow, said: "This course really highlighted leadership qualities that are often taken for granted. The course demonstrates that you do not need a status position in order to demonstrate effective leadership even though status positions are often where we look for leadership. I would recommend this course to both vets and nurses in clinical practice - it's a real eye opener, and as a result of doing the course perhaps we can see less age-restricted approach to leadership within the veterinary profession?"

Given the overwhelmingly positive feedback received on the first course the RCVS has now opened the programme to all veterinary professionals.

The programme is now accepting registrations for a new cohort of learners to begin the first of three courses on 26^th November.  A ‘sign-up’ email will be sent out to all veterinary surgeons and veterinary nurses ahead of the course starting.

Director of Leadership and Innovation at the RCVS, Anthony Roberts, said: "I am very pleased to be able to announce the launch of this programme. I would urge anyone with an interest in developing their leadership skills, as well as those looking to refine their longstanding leadership skills, to take part. The feedback we have received on the first course in this programme [please see Notes to Editors] has shown us that this MOOC has a far-reaching application, and is both educational and enjoyable. Whether you are a vet, veterinary nurse, practice manager or student, this programme will be relevant and useful in your professional career."

For more information, visit: www.rcvs.org.uk/leadershipmooc or email: leadership@rcvs.org.uk

Linnaeus, the corporate veterinary group with 130 practices around the UK that was bought by Mars Petcare earlier this year, has made a £60,000 donation to Vetlife, the charity which gives free confidential support to veterinary professionals who have emotional, health or financial difficulties.

The charity, which was set up over 120 years ago, says the number of calls and emails it gets from industry professionals seeking help has increased 500% over the last 5 years; it has received more than 1,500 calls and emails over the past 12 months. 

Lynne Hill, Chief Executive of Linnaeus said: "The veterinary industry is fast-paced and, at times, an extremely stressful environment, so the support on offer from Vetlife is particularly valuable and its worth is demonstrated by the significant increase in contact being made to it.

"We hope this donation will help Vetlife continue to provide the excellent service and support they have given to vets and nurses for so long." 

Vetlife President Geoff Little said: "This donation from the Linnaeus Group is extremely generous. We have seen a dramatic rise in calls and emails to the service over recent years. So much so, we have recruited additional volunteers to cope with the additional contacts.  It’s extremely gratifying to see the number of volunteers who are so willing to put something back into their profession and to help others.

"At Vetlife, we provide support in the shape of three core services, which are the Vetlife Helpline, which provides independent, confidential support 24/7, 365 days a year; Health Support, run by mental health professionals; and Financial Support, which provides assistance to vets or their dependents who find themselves in difficulty. 

"This support from Linnaeus will help us to bridge the gap as the need for support continues to grow." 

Anyone who needs support can contact the Vetlife Helpline on 0303 040 2551 or anonymously via www.vetlife.org.uk. 

Photo: Vetlife President Geoff Little receives the £60,000 donation from Lynn Hill at Linnaeus. 

PBD Biotech Limited has launched Actiphage, a new test which the company says enables rapid, early identification of Mycobacterium bovis in exotic species.

PBD says Bovine tuberculosis (bTB) is a growing problem for zoos and wildlife parks, especially with the disease’s potential to spread from one species to another, creating a natural reservoir that is difficult to control.  

bTB in zoos came to public attention last year when Devon’s Paignton Zoo detected a single case in one of its antelope. Without access to a test that would deliver rapid results, the zoo had to cull the remaining 10-strong herd of Kafue Flats lechwe. 

PBD says the Actiphage test can identify bTB and other mycobacterial diseases in animals before clinical symptoms of infection are observed. It can detect with high specificity the presence of any mycobacteria in animal blood within 6 hours in comparison to culturing mycobacteria, which can take up to 12 weeks.

The technology has been successfully applied to blood samples from 17 different species so far, including deer, goats and badgers as well as exotic animals such as lions, giraffes, antelopes, elephants, tigers, kangaroos and camels. Trials have confirmed PBD Biotech’s assay can detect live mycobacteria in blood or milk samples at very high sensitivity, of less than 10 mycobacterial cells per ml of sample.

The test is being presented to delegates at the British Veterinary Zoological Society (BVZS) Congress in Birmingham today by Dr Ben Swift, Research Fellow at the Royal Veterinary College and R&D Director at PBD Biotech.

He said: "The Actiphage detection method provides a major step change in the detection of viable mycobacteria and has the potential to revolutionise the control and understanding of mycobacterial diseases in zoo animals, wildlife and a range of other species.

"The use of bacteriophage means the test can detect mycobacteria before an immune response is fully developed, giving vets, zoo-keepers and other exotics experts a head-start on the race to catch bTB and other diseases in the hope of preventing the unnecessary cull of protected animals."

A motion to conduct a trial of remote prescribing without performing a physical examination (ie. via telemedicine), thereby redefining what it means for an animal to be "under the care" of a veterinary surgeon, was put before RCVS Council last week. I was there to hear the arguments …

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!

New research from the RVC has revealed that young, male, crossbred cats are at greater risk of being hit by a car, begging the question as to why they tried to cross the road in the first place.

The study, which was carried out by the VetCompass programme at the RVC, in partnership with Vets Now, also found that cats are most likely to be involved in a traffic accident in the autumn. 

1,407 cat road traffic accident cases that attended Vets Now clinics across the UK between December 2011 and February 2014 were analysed, with researchers finding: 

• Younger cats, aged six months to six years, are at the greatest risk of road traffic accidents.

• Male cats are 1.3 times more at risk of road traffic accidents than female cats. 

• Crossbred cats are 1.9 times more at risk of road traffic accidents compared to purebred cats.

• Cats are more likely to be involved in a road traffic accident in the autumn. However, they are less at risk in winter as compared to spring.

• Those cats that present with abdominal or spinal injuries are more likely to die, as are those that present with an increasing count of injuries.

• The 1,407 cats that were admitted after being hit by a car represented 4.2% of all cats treated at emergency veterinary clinics (n=22,586) during the period. 

RVC veterinary epidemiologist and VetCompass researcher Dr Dan O’Neill said: "One of the scariest times for any cat-owner is when they first start to let their cat go outside unattended. Owners of younger, and especially male, cats need to be especially vigilant. These results help owners to understand the true risks and therefore assist these owners to make the best decisions about if and how they let their cats go outside."

Dr Amanda Boag, Clinical Director of Vets Now, said: "We are very proud to have worked with VetCompass to ensure this important information about risks to our pet cats is made available to vets and the public. Working with our partners such as the RVC, we are committed to ensuring our large clinical database is used to help advance veterinary knowledge and understanding of emergency and critical care practice."

The full paper entitled 'Epidemiology of Road Traffic Accidents in Cats attending emergency-care practices in the UK' is published in the Journal of Small Animal Practice.

Invicta Animal Health has launched an improved version EthyCalm, its vapo-coolant spray for desensitising skin before needling a patient.

EthyCalm is sprayed directly on the skin, or, for more fractious patients, can be applied with a swab. 

Invicta says that unlike other products the effect is instant and EthyCalm leaves no residue on the skin surface.

The improved product, EthyCalm Plus, contains 50% more product (good for over 100 applications) and incorporates a new 'on-off' switch for easier application. It is also now packed in a 'no-roll' case to protect from damage.

Rob Watkins, Managing Director of Invicta, said: "EthyCalm has been an incredibly popular product with nurses and vets. As a small company we always listen to our customers and have taken the opportunity to incorporate suggestions for improvement. The result is EthyCalm Plus which offers significant enhancement over the original product".

EthyCalm Plus is available from veterinary wholesalers and for a limited time the price has been held at £25 each.

The RCVS reports that its Veterinary Client Mediation Service (VCMS) has passed the one-year mark, dealing with over 2,000 disputes between veterinary practices and clients in that time.

The VCMS, which is administered by Nockolds Solicitors, was formally launched by the RCVS as an alternative dispute resolution service in October 2017 following a year-long trial.

The aim of the service is to resolve, by mediation, disputes between clients and veterinary practices that do not meet the threshold of serious professional misconduct that is needed for the RCVS to investigate a concern through its formal processes.

Since the service’s trial, which started in October 2016, the VCMS has given preliminary mediation advice on how to resolve a case in more than 1,700 instances with over 580 cases having gone to full mediation of which 89% have concluded with a resolution. 

Eleanor Ferguson, RCVS Registrar and Director of Legal Services, said: "From the perspective of both the public and the profession, the establishment of the VCMS has been a "win-win" situation. For the public it has provided them with an additional route to solve those complaints which wouldn’t cross the threshold to progress in the concerns investigation process.

"For the profession it has provided a more appropriate format for resolving a client dispute that doesn’t involve the time, effort and formal process of an RCVS investigation for those cases that will never amount to serious professional misconduct. I think this has been demonstrated by the fact that the vast majority of the profession are willing to engage with the VCMS process, even though it is entirely voluntary.

"The VCMS has also had a positive impact on the College and its concerns investigation process, allowing us to focus greater resources on those cases that do meet our threshold of serious professional misconduct. This has had a very clear impact on the speed with which we either close cases or move them on to the next stage of consideration by the Preliminary Investigation Committee (PIC), which, again, is important to both the public and the profession."

The College says that around 90% of cases investigated at Stage 1 of the process are now either closed or referred to PIC within four months – the College’s key performance indicator at this stage. This compares to around 50% of these cases being closed or referred within four months at Stage 1 in 2016.

The College also says that in total (including both preliminary and full mediation cases), 86% of the cases dealt with by VCMS were successfully mediated and feedback from both clients and veterinary practices has been largely positive. In client feedback from the third quarter of 2018, 93% said they would use the VCMS again and 79% considered it to be fair, while the equivalent figure amongst veterinary practices was 94% and 87% respectively.

Jennie Jones, a partner at Nockolds Solicitors who heads up the VCMS, said: "It is a good sign that mediation is largely working as it should when both parties are reporting similar satisfaction rates and we pride ourselves on negotiating resolutions that are acceptable and beneficial for both the clients and the practices.

"It is great to see that our efforts are also having an impact on the RCVS concerns investigation system by allowing it to concentrate on more serious cases."

More information about the RCVS concerns investigation process, including the different stages of an investigation, can be found at www.rcvs.org.uk/concerns

Further information about the VCMS can be found on its website at www.vetmediation.co.uk or by calling 0345 040 5834.

The RCVS has published a series of case studies designed to help veterinary surgeons and veterinary nurses in gaining properly informed consent from clients for procedures and treatments.

The case studies were developed by the RCVS Standards Committee and use a variety of examples of where miscommunication between a client and the veterinary practice can lead to an inadequate level of consent being gained for procedures and treatment, including euthanasia.

Examples include damaged teeth being removed during a clean and polish dental procedure without the owner’s express permission and not giving the full range of options available in the case of a dog with an osteosarcoma.

The case studies follow the Standards Committee approving changes to chapter 11 (‘Communication and consent’) of the supporting guidance to the RCVS Code of Professional Conduct in January 2018 to give further advice on how to discuss informed consent with clients, who can be responsible for gaining consent for a procedure and additional guidance on consent forms.

Dr Kate Richards MRCVS, Chair of the RCVS Standards Committee, said: "We hope these case studies will prove useful to practitioners who are having to deal with the complexities around making sure that procedures are fully explained to ensure informed consent is gained.

"We understand the difficulties that are encountered and so these case studies, based on real-life scenarios, highlight where things may go wrong and how these incidents can be avoided by being thorough and ensuring that good communication is at the heart of all we do."

To view the case studies, visit www.rcvs.org.uk/informed-consent.

Chapter 11 of the RCVS supporting guidance on communication and consent is available to view at www.rcvs.org.uk/consent

Lintbells has launched its 'new and improved' Mobility Matters initiative which provides a framework for introducing nurse–led mobility clinics in practice.

The Lintbells Mobility Matters initiative provides materials designed to help improve communication and client understanding of their pet’s condition. It includes a guide on how to set up a mobility-focused nurse-led clinic, together with a step-by-step guide in a flip chart format to help RVNs recommend dietary supplements or modifications. 

To help launch the clinic, Lintbells Veterinary Business Development Executives can provide lunch and learn sessions. Practices can also become approved Mobility Matters practices with certified CPD for the whole team to ensure that the process of recommendation and referral to the clinic occurs seamlessly and involves everyone in the practice. 

Yumove Brand Manager Gemma Cunningham said: "Feedback about the pack is that it helps vets and vet nurses explain mobility problems to owners in a simple but structured way to improve buy-in to a multimodal approach".

Practices that want to register an interest in the initiative can contact their local Lintbells Veterinary Business Development Executive or visit www.lintbellsvet.com.