VET Festival organisers have announced that American physical therapist and Master Yoga teacher Lara Heimann will be joining clinical experts from around the world on the speaker panel of VET Festival 2019.

The two-day event, now in its fifth year, aims to combine world-class CPD for the whole practice team with an outdoor ‘festival’ atmosphere.   

The organisers say that the wellbeing of veterinary professionals has always been a strong focus of VET Festival, but the inclusion of Lara Heimann in the Wellness and Practice Development lecture, takes it to a new level. Laura has developed her own vinyasa yoga style and regularly leads international retreats and workshops.

Speakers in the clinical programme will include:

• Dr Antonio Pozzi, Head of the Clinic for Small Animal Surgery at the University of Zurich, Switzerland

• Dr Susan Little, co-owner of two feline specialty practices in Ottawa, Canada, and past president of the American Association of Feline Practitioners

• Dr Ronaldo da Costa, Professor in Neurology and Neurosurgery at Ohio State University, USA.

• Veterinary cardiologist Professor John E Rush.  A Diplomate of both the American Colleges of Veterinary Internal Medicine and Emergency and Critical Care, Dr Rush has been a professor for 25 years at the Cummings Veterinary Medicine Centre at Tufts University in Massachusetts

• Behaviourist Dr Sarah Heath. A founding Diplomate of the European College of Animal Welfare and Behavioural Medicine

• Soft-tissue surgeon Professor Christopher Adin. Professor Adin is Chair of the University of Florida’s Department of Small Animal Clinical Sciences and Associate Professor of Soft Tissue.

Veterinary nurses are welcome to attend any of the lectures, in addition to those in the dedicated nursing stream. An exhibition of the latest products and services for all veterinary professionals takes place in a dedicated arena.

Nicole Cooper, event director, said: "VET Festival is unique in bringing together cutting-edge, inspirational learning, fun and the great outdoors. CPD from our world-leading speakers is delivered in a high quality and contemporary setting but, once work is done, we encourage delegates to relax and enjoy free admission for them, their friends and family to the VETFest Live Party Night."

She added: "With the wellness and wellbeing of members of our profession increasingly in the spotlight, we’re delighted to welcome Lara Heimann for 2019 and hope that she will help our delegates to develop practical solutions to living healthier and more balanced lives."

Supported by MWI Animal Health, VET Festival also offers a 'Family Hub', a place where children can play whilst their parents listen to lectures. 

Alan White Group Commercial Director at MWI Animal Health, said: "Balancing work and family life can often be a juggling act, particularly in the veterinary profession where time is in short supply. This can sometimes compromise the work-life balance of vets, nurses and other team members. At VET Festival, the 'Family Hub' means that there is no compromise and that both our attendees and their families can get the best out of their time with us."

You can buy tickets here: https://www.vetfestival.co.uk/delegate-info/ticket-information

Ceva Animal Health has launched two new tongue-in-cheek TV ads which show people hiding in fear when visitors arrive, scratching furniture and urine spraying in order to highlight behaviour patterns which Adaptil and Feliway are designed to help with.

Ceva says the adverts, which will air on Channel 4 and Channel 4 partner channels until 20th January, will reach 15 million people. That might prove a conservative estimate though, because the Adaptil advert on YouTube has already had over 800,000 views, whilst the Feliway advertisement has had very nearly as many.

In addition, Adaptil has partnered with The Times to support its 'Walking the Dog' podcast series hosted by radio presenter and journalist Emily Dean.

During the podcasts, Emily talks with celebrities like Noel Fitzpatrick, Jimmy Carr, Rob Bryden and Jonathan Ross as they walk their dogs. An Adaptil advert airs at the start, middle and end of each podcast.  

You can hear the podcasts on itunes here: https://itunes.apple.com/gb/podcast/walking-the-dog-with-emily-dean/id1220510307 

Abigail King, behaviour product manager at Ceva Animal Health said: "Our new TV advertising campaigns and podcast partnership will boost awareness of both Adaptil and Feliway throughout the festive period and into January, when changes to routine, visitors in the household and loud noises from Christmas crackers and fireworks can challenge even the most laid-back pet."

For more information, visit: www.adaptil.com or  www.feliway.com.

Dechra Veterinary Products has launched Dermanolon, a new symptomatic treatment to tackle seborrhoeic dermatitis in cats and dogs.

Dermanolon contains triamcinolone acetonide and salicylic acid. Presented in a 75ml spray bottle, Dechra says it is designed to target lesions in hard to access spots and is a useful alternative for animals when shampooing is not possible.

Triamcinolone acetonide, a moderately potent steroid with an anti-inflammatory and vasoconstrictive action, suppresses the inflammatory response and the symptoms of various disorders often associated with itching.

Salicylic acid gives a keratolytic effect and also removes excess skin cells when applied cutaneously and provides a drying effect, which prevents maceration.

Dechra Brand Manager Carol Morgan said: "Seborrhoeic dermatitis is associated with a higher skin pH compared to that of healthy dogs so Dermanolon’s low pH of approximately 2.7 reduces the pH of the skin following application giving an antibacterial and antimycotic effect.

"It also contains ethanol that prevents the build-up of a greasy film on the skin and has bactericidal properties."

Carol added: "Seborrhoeic dermatitis can be a debilitating condition for animals and a challenge to treat effectively. Adding Dermanolon to our portfolio offers veterinary professionals another valuable tool for the care and treatment of animals with dermatological diseases."

For more information on Dechra’s dermatology range, visit: www.dechra.co.uk.

Vetlife is asking everyone in the profession to pledge their support after having its busiest year yet.

The charity-run Vetlife helpline, which offers 24/7 confidential support, says it had 2775 contacts from members of the profession last year, up 160% on the previous year.

Vetlife Operations Manager Joanne Driver said: "We’re aware that for many the impact of seasonal work pressures for vet practices and the stresses of the already hectic Christmas period do not simply disappear when January arrives. When paired with mental health issues or personal worries, it can continue to feel overwhelming.

Vetlife helpline is a safe place to talk for those who are struggling, and our volunteers can signpost callers to resources and our health and financial services.

"It can be hard to spot colleagues who are struggling or to find ways to offer the help they need. By supporting Vetlife you can help us ensure there is a friendly anonymous voice at the end of the phone or via email for everyone in the veterinary community who needs it. Vetlife is largely run by volunteers and we rely on your support and donations to keep the services running.

"Please make a meaningful resolution this year and support Vetlife through a donation, by becoming a member or by joining as a volunteer."

If you would like to support Vetlife, there are a number of ways to help:

Donate
As a registered independent charity, Vetlife relies on the generosity of the people in the veterinary community and veterinary organisations to be able to continue its work. The simplest way to donate is online at: www.vetlife.org.uk/support-us/donate/

Volunteer
Vetlife is almost entirely managed and run by its volunteers. To learn more about volunteering for Vetlife Helpline or as an Area Representative, visit www.vetlife.org.uk/support-us/volunteer/

Vetlife Helpline is available on: 0303 040 2551 or email via www.vetlife.org.uk

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!

Medivet has announced a partnership with the Royal Veterinary College (RVC) through which its veterinary nurses will be able to access CPD courses on a range of topics including Emergency and Critical Care, Diagnostic Imaging and Anaesthesia and Analgesia.

Medivet says each topic is covered in a six-week module, delivered online by RVC lecturers using a blended learning approach to encourage learners to think critically. On successful completion of a module, the participant will get up to 18 hours’ CPD and a certificate from the RVC.

Rachel Mattia, Head of Learning and Development at Medivet, said: "The Medivet Training Centre delivers the initial training our nurses need to qualify as Registered Veterinary Nurses. Building on this, our partnership with the RVC means that we can now support their continued development by giving them access to state-of-the-art CPD from recognised experts in an engaging, interactive format that they can fit in around their work and home life."

"Our nurses are the lynchpins of our practice teams and we are committed to investing in their development throughout their careers through initiatives such as this partnership with the RVC."

Feline charity International Cat Care (iCatCare)'s annual cat photography competition is now open for entries.

This year, in collaboration with Your Cat, the charity is looking for entries which showcase the cat-human bond with a brand new theme of ‘Cat-Human Relationships’.

The judges want to see a range of relationships in a variety of situations, locations and ages. For instance, entries can include but are not limited to: pet cats with their owners in the home, street cats with the public and cats with those who work with them eg, veterinary professionals with their patients and homing centre workers with the cats in their care.

Since its launch in 2013, the competition has collectively attracted over 15,000 entries from all over the world.

Eve Davies, who runs the competition, said: "Whilst we tend to think of our relationship with cats as that of pet and owner, cats and humans can have a huge variety of unique connections with each other and we would love to see this reflected in the entries.

"This year’s theme is quite different to previous topics – for example kittens or sleeping cats – but it has the potential to be much more rewarding. As well as receiving exceptional photos over the years, we have been sent some incredibly moving stories to accompany them and we are hoping that this year will be even better still."

Twelve winning images will be selected by the iCatCare and Your Cat Magazine judges to feature in the charity’s 2020 calendar (and other materials) which will be sold to raise funds for the charity’s work, with one crowned the overall winner and gracing the front cover.

All twelve winners will each receive a certificate, copies of the calendar and a selection of iCatCare merchandise. The overall winner will also receive £500 in prize money.

To find out more and to enter, visit: www.icatcare.org/photography-competition. The competition closes at 10 am (BST) on 1 July 2019. 

Elanco has announced that Galliprant (grapiprant), its new treatment for canine osteoarthritis pain, is now available in the UK.

Galliprant is a first in a class of drugs called piprants, or non-COX-inhibiting prostaglandin receptor antagonists (PRAs), which specifically target the EP4 receptor largely responsible for OA pain and inflammation^1,3 without interfering with other prostanoids and receptors, thereby minimising the impact on gastrointestinal and kidney homeostasis.^1,4

According to Elanco, the main benefit of the new drug is that it can be given in the earlier stages of the disease; from first diagnosis in fact. Speaking at the London Vet Show in 2018, Dr Kristin Kirkby Shaw, Surgeon and Rehabilitation Specialist at the Animal Surgical Clinic of Seattle, said: "…being much more targeted, it makes us feel more comfortable starting this product in an earlier stage of osteoarthritis."

In the target animal safety study, Galliprant was well-tolerated over 9 months at doses equivalent to 15 times the target dose.⁵ Kristen said: "I challenge anyone to think of another product that has been given in a safety study at that high of a level for that duration of time."

The efficacy of Galliprant was demonstrated in the field study at the licensed target dose of 2mg/kg body weight, with treatment success seen by owners in their dogs at home, and confirmed by vet assessment.² Owners saw statistically significant improvements in pain severity and interference with daily activities vs placebo at days 7, 14, 21 and 28.²

For more information, visit www.galliprant.co.uk. You can also watch Dr Kristen Kirkby Shaw's London Vet Show presentation and other expert opinion here.

References:

1. Kirkby Shaw K et al. Vet Med Sci. 2016;2:3-9. 
2. Rausch-Derra L et al. J Vet Intern Med. 2016;30:756-763. 
3. Woodward DF et al. Pharmacol Rev.2011;63(3):471-538. 
4. Giorgi M. Am J Anim Vet Sci. 2015;10(2):53-56. 
5. Rausch-Derra LC et al. Am J Vet Res. 2015;76(10):853-859.

White Cross Vets in Sheffield is to star in The Pets Factor, a new television series being broadcast on CBBC later this year.

The show follows veterinary surgeons and nurses going about their day-to-day work, consulting and operating on a variety of cases from the routine to the extraordinary. 

The ten-episode series stars Cat Henstridge, who many will be familiar with for her social media posts as 'Cat the Vet', and her husband Dave Hough who is the Clinic Director at the practice.

Cat said: "I know from the reactions I get on my website and social media channels that there is a huge level of interest in what we do, and the TV programme will help to bring those real-life stories directly to a younger audience, as well as offering exclusive behind the scenes access to everything that happens in our busy veterinary practice."

Dave added: "We are thrilled to be showcasing the fantastic work of our dedicated and talented team. What we see every day is so varied, and we are driven by our love of pets and the ability to help heal them. It’s a real delight to think that our work will be seen on television, and hopefully inspire the next generation of vets, nurses and support staff to work in this really rewarding profession."

The RCVS has announced that there will be no election for the Veterinary Nurses Council this year, because only two candidates stood for the available two places.

The two candidates were VN Council Vice-Chair Liz Cox and newcomer Jane Davidson.

Both Liz and Jane will start their three-year terms on VN Council at Royal College Day on Friday 12 July 2019.

Racheal Marshall, Chair of VN Council, said: "First, I would welcome our new VN Council member Jane Davidson who is well-known to many in the profession as @JaneRVN, a prolific tweeter on all things #planetrvn and a powerful advocate for the veterinary nursing profession through her work with the media, including her regular Vet Times blog. I also wish to congratulate Liz who I am sure will continue to be a great asset to VN Council for a further three years.

"However, it is disappointing that there were not enough candidates standing for us to hold an election this year and give the profession the opportunity to exercise their democratic right and decide who they wish to elect. We will be taking stock of the situation over the next few months and considering how we can do more to promote the activities and decisions of VN Council and its members in the hope that, next year, we will see an increase in the numbers standing as candidates."

The Animal Health Trust (AHT) has announced the launch of a new DNA test for the genetic mutation which causes glaucoma in Border Collies.

According to the AHT, glaucoma affects more than a thousand dogs across the UK. Now Border Collie breeders will be able to use this test to reduce the risk of producing glaucoma-affected puppies, whilst maintaining genetic diversity.

The work that resulted in the new test began at the Roslin Institute in Edinburgh, where scientists found a variant in a gene called OLFML3 reported to be associated with severe goniodysgenesis and glaucoma in Border Collies.

On reading this research, the AHT’s canine genetics team, which has an ongoing research programme looking at canine glaucoma, began to look at how a DNA test could be offered based on the mutation.

Hattie Wright, Vets4Pets Research Assistant at the AHT, genotyped a large cohort of Border Collies for the mutation, in order to obtain an accurate measure of the association between the mutation and goniodysgenesis and glaucoma in the Border Collie. These dogs all had their eyes examined, and their DNA collected, by veterinary ophthalmologist James Oliver.

The charity’s findings from this validation process replicated the findings of the Roslin Institute, so the AHT has been able to develop and launch a DNA test based on the reported OLFML3 mutation.

Dr Cathryn Mellersh, Head of Canine Genetics at the Animal Health Trust, said: "We’re delighted to offer this test to Border Collie breeders and hope in time, through its use, we can lessen the prevalence of this disease in this lovely breed.

"Our research has found that the mutation is only associated with glaucoma in Border Collies, so we will publish our data at the earliest opportunity, in the hope that other commercial DNA testing providers will not be tempted to make the DNA test available to breeds other than the Border Collie."

For more information, visit: www.ahtdnatesting.co.uk 

The British Veterinary Receptionist Association (BVRA) has announced that Kendall Clee from Blacks Vets in Dudley has won its first Veterinary Receptionist of the Year award.

The Association had over 100 entries for the awards from both veterinary staff and clients. The two runners-up were Laurie Williams from Vets4Pets, Hereford in second place and Kristin Hardin from Maven Vets, North Cheam in third place.

The winners were chosen by an independent judging panel who, despite the high standard of entries, all chose the same top three finalists. Each received an award, certificate and vouchers.

Kendall Clee said: "It’s absolutely amazing to win. Everyone at my practice is a joy to work with, so they’ve played a part in this too, as they make my job easier."

Kay Watson-Bray, who founded the BVRHA with Brian Faulkner, said: "We’ve had such a fantastic response from colleagues and clients wanting to recognise the efforts of their veterinary receptionists.

"The stories they shared were really heart-warming and it was clear that not only are veterinary receptionists appreciated, they make a considerable contribution to practice success.

"We’ll be sending everyone nominated a certificate to mark their achievements and would like to extend our thanks to anyone who took the time to nominate their favourite veterinary receptionist.”

For more information, visit: www.bvra.co.uk.

Photo: Left to right, Kendall Clee, Brian Faulkner, Kay Watson-Bray