Urging vets to 'get off their backsides and respond to a VMD consultation' on the introduction of a new POM-EA category (Vet Times, 19^th October) is premature.

Contrary to the report, the VMD has not yet launched a formal consultation.

Jo Cawthorne from the VMD said: "In fact, we've only launched an informal consultation on a concept note amongst a small group of key stakeholders from the RCVS, BVA,  RPSGB, AMTRA, AHDA  and NOAH, in order to decide whether  this is a viable idea and merits a formal consultation."

She added: "There is no need for vets to respond to a consultation which doesn't yet exist. If there is a formal consultation, it will be announced formally on our website and everyone will be given the opportunity to respond."

The University of Bristol's School of Biological Sciences has published* the results of a study which concludes that young dogs and those that are not wormed regularly are significantly more likely to be infected with the life-threatening, parasitic lungworm, Angiostrongylus vasorum.

In the independent study, which was led by Dr. Eric Morgan,  the faeces of 900 dogs was tested to look for factors which may increase a dog's risk of infection and to identify signs of infection. Lungworm was found to be a common cause of disease in Southwest England and Wales - 16 per cent of dogs presenting symptoms tested positive for lungworm, as well as 2 per cent of seemingly healthy dogs.  However, this is likely to be an underestimate. Dr Morgan said: "We used the Baermann's test to identify infected dogs, which is thought to be only 50% accurate, so the true figures may be as much as double those reported."

Dogs under 18 months were found to be 8 times more likely to have lungworm than dogs over 8 years old, and dogs between 18 months and 8 years old were 4 times more likely to have lungworm than dogs over 8 years old.  Dogs tested positive for lungworm year-round but there was an increase in numbers diagnosed during the winter and spring.

According to Dr. Morgan, infected dogs may display a wide range of symptoms: while over half of infected dogs were reported to be coughing or having difficulty breathing, lungworm infection is not always associated with respiratory signs. Infected dogs may present any combination of a wide range of symptoms including lethargy, tiring easily with exercise, and gastrointestinal signs such as vomiting and diarrhoea.  A significant number of infected dogs displayed signs of bleeding disorders such as excessive bleeding from small wounds or following surgery, blood in the urine and vomit, pale skin and bleeding in the eyes and skin.

Dr. Morgan added: "This parasite is spreading, reaching many new areas (including Bristol and Scotland) in the last few years.  Disease can present in a variety of ways, not necessarily involving respiratory signs, so pet owners and their vets should be aware of the risk.  Disease is most common in younger dogs, though age is not a barrier to infection.  On the bright side, dogs that are treated regularly with appropriate wormers are at lower risk, so we can act to protect our pets' health."

*Morgan, E. R., Jefferies, R., van Otterdijk, L., McEniry, R. B., Allen, F., Bakewell, M. and Shaw, S. E. 2010. Angiostrongylus vasorum infection in dogs: Presentation and risk factors. Veterinary Parasitology. doi:10.1016/j.vetpar.2010.06.037

Janssen Animal Health is encouraging vets and nurses to think 'chicken' this spring.

According to the company, all the evidence suggests that there has been a massive increase in the number of people keeping a few chickens in their garden, resulting in a new breed of chicken owner who often has different expectations regarding healthcare, and views their birds as 'pets'.

Vet Nigel Underwood from Janssen Animal Health said: "It is very tempting for small animal practitioners to think that domestic poultry keepers are the preserve of large animal practices but it is very likely that many cat and dog owners will own chickens too and trust their vet to give them advice about the basic healthcare needs of all their pets."

This spring there is a big opportunity to make poultry owners aware of the need to worm their birds. The return of warmer weather can signal an increase in poultry worm numbers as the ambient temperature increases above 10 degrees centigrade and more worm eggs become infectious. Studies have shown that peak worm counts often coincide with peak chicken egg production. Unless chickens, turkeys and geese are de-wormed there is a risk that egg production could suffer, just when poultry keepers should be enjoying their best yields.  Some may even notice smaller eggs and loss of shell and yolk colour. Birds may suffer weight loss, become anaemic or even die.

One study has shown that older birds are more likely to harbour worms and many domestic poultry keepers find themselves with an ageing flock because they allow their birds to live a full natural lifespan. Free range birds are also much more at risk of picking up parasitic worms because of increased exposure to the outdoors, more contact with wild birds and the opportunities to ingest intermediate hosts such as earthworms, beetles and snails. 

Janssen Animal Health's Flubenvet® 60 gram pack is an in-feed treatment that, according to the company, is practical even for those with just a few hens in their garden. Flubenvet 60 gram contains enough wormer to treat around 20 chickens, with no egg withdrawal.

While worms are a year-round problem in poultry it is especially important to treat in the spring to tackle the increasing threat of worm infection. Thereafter, poultry owners will also get the best results if they continue to treat regularly in spring, summer and autumn, when new birds are acquired and before putting birds out to pasture. This helps to ensure that contamination of the chickens' environment with worm eggs is kept at a manageable level, reducing the risk of future infections.

Free client leaflets about worms affecting chickens, geese and turkeys are available by calling Janssen Animal Health on 01494 567555.

Petplan has launched a new look policy range to give pet owners more comprehensive cover and make it easier for them to understand the types of cover available.

Simon Masding, Petplan's Head of Sales and Partnerships said the refreshed policies will not only benefit the pet and their owner but the changes will also allow veterinary staff to explain the policies with a lot more clarity: "Since Petplan started 35 years ago the pet insurance market and vet industry has changed significantly, especially in the last few years. There are now over 250 policies in the market with varying benefits and levels of cover, which often confuses customers to a point where they think they're getting lifetime cover but they're instead trapped with a restrictive policy.

"The veterinary industry is also continually changing with advances in new technology and better diagnostics allowing the industry to save and treat more pets, which means our policies need to evolve with them."

To better understand these changing market dynamics, Petplan held focus groups with veterinary staff from across the UK and undertook extensive research with charities, breeders, customers and non-customers.

Apparently, the feedback showed that Petplan needed to communicate its range of policies more clearly, to shift away from the confusion created by other brands and meet the changing demands of the vet industry and pet owners better.

For this reason, Petplan says it has simplified its policy range, adding and increasing each policy's benefits, making a 12 month policy available for practices to offer, and developing easy-to-understand policy names.

Petplan's new look policies for both cats and dogs are: 

• Petplan Ultimate - Petplan's most comprehensive Covered for Life plan with exclusive additional benefits and up to £12,000 vet fee cover for complete peace of mind. Maximum protection for maximum reassurance.
• Petplan Classic - Petplan's most popular plan providing comprehensive Covered for Life pet insurance for accidents and chronic illnesses. The original Covered for Life policy.
• Petplan Essential - providing high quality 12-month cover for accidents and illness. Petplan quality at an affordable price.

Petplan says its Covered for Life policies, Petplan Ultimate and Petplan Classic, will continue to provide pet owners with the best cover in the market. However, the company recognises that these policies are not always suitable for people with older pets or a limited budget.

Simon said: "Petplan Essential, our 12 month policy, will also now be available for veterinary staff to offer to their customers. While our Covered for Life Ultimate and Classic will continue to be our leading policies and at the heart of what we do, it's better that a pet owner has some type of cover rather than nothing at all and Essential is a market leading 12 month policy."

Zeta Frasca, practice owner and vet at Kitten to Cat in Richmond London said: "These changes will not only make it clearer for the pet owner but it will also make it a lot easier for us as an industry to explain pet insurance to our clients, which is really important."

For more information about Petplan's new look policies visit www.petplan.co.uk, call their dedicated Vetline on 0800 3168 8900 or talk to your Petplan Business Developer.

The following table outlines each policy and its benefits:

A new study carried out by researchers at the Yale School of Medicine and Yale Cancer Center, published in the Journal of the National Cancer Institute, has found that human cancer patients who use alternative medicine are up to 5.7 times more likely to die early than those who use conventional medicine.

Researchers studied 840 patients with breast, prostate, lung or colorectal cancer. 280 patients that had received only alternative medicine were matched to 560 control patients who chose conventional cancer therapy.

Overall, cancer patients who used alternative medicine were 2.5 times more likely to die within a 5 year period than those who chose conventional cancer therapy.

However, people with breast cancer were 5.7 times more likely to die in the same period if they used alternative medicine rather than conventional medicine.

This evidence flies in the face of the British Association of Veterinary Homeopathic Veterinary Surgeons' claim that homeopathy cures cancer.

But more importantly, one of the main reasons why practitioners in both human and veterinary medicine so often acquiesce to their patients' use of alternative medicine is because of the perception that they do no harm. After all, homeopathy is only water, right?

This study provides perhaps the first evidence that the reverse may be true. That if you do not actively deter clients from using discredited forms of alternative medicine, you may be allowing them to sentence themselves, or rather their dog, to an early death.

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!

Nominations are now open for candidates wishing to stand in the 2012 RCVS Council and RCVS Veterinary Nurses Council elections.

Jane Hern, RCVS Registrar said: "The veterinary surgeons and veterinary nurses that sit on the RCVS and VN Councils are vital to the governance of their professions, and in steering the activities the College undertakes under its Royal Charter. If you're interested in making sure that your profession is well-governed, its standards are upheld, and the interests of animals and the public are protected, why not consider standing in these elections?"

Six seats on RCVS Council and two on VN Council are due to be filled in the 2012 elections. Those elected will take their seats on RCVS Day next July, to serve four-year terms, and will be expected to spend at least six to eight days a year attending Council meetings, working parties and subcommittees (a loss-of-earnings allowance is available).

All prospective candidates need to provide the signatures and registered/listed addresses of two proposers, and should also submit a short biography, manifesto and photograph for inclusion in the RCVS News Extra election specials. Nobody may nominate more than one candidate, and no current member of the RCVS Council or VN Council may make a nomination.

Nominations must be made in writing on the prescribed form and received by the Registrar on or before the closing date of 31 January 2012. Full details and guidance notes for both elections will be available on the RCVS website shortly on the RCVS Council Election page and VN Council Election page. 

Nomination forms and candidate information forms for RCVS Council may be requested from Mrs Gabi Braun (020 7222 0761 or executiveoffice@rcvs.org.uk) and those for VN Council from Mrs Annette Amato (020 7202 0713 or a.amato@rcvs.org.uk).

Pet Blood Bank UK (PBBuk), the first charity which collects, processes, stores and supplies pet blood products in the UK, has announced its Board of Trustees.

They are: Phil Nuttall, former Head of the National Blood Service Sheffield Centre, Dr. Freda Scott-Park, immediate Past President of the British Veterinary Association, John Michael Hill, President Elect Society of Practising Veterinary Surgeons and Wendy Barnett, Executive Director of PBBuk.

The five members of the newly convened board will ensure the long-term health and effectiveness of PBBuk and will play a key role in developing the business plan for the organisation as well as formulating strategy and supporting fundraising activity to ensure the charity has a sustainable future.

Organisers of the Vet Charity Challenge are calling for more people to take part in the event, to join the 100 that are already set to walk, run, cycle, kayak and orienteer around the grounds of the Royal Agricultural College in Cirencester on On 15^th September.

Gavin Mitchell from BCF Technology said: "We have entered two teams and already have a £100 bet on which of our teams will gain the most points on the day. This rivalry has certainly had a positive influence on the amount of training we are all doing to prepare for the challenge. The teams are out cycling after work and off for runs during lunchtimes."

Gavin added: "We are keen to ensure we beat the other teams such as those from Vets Now, and Clent Hills Vet Group. No pressure!"

Teams are also starting to gather sponsorship for the three chosen charities of SPANA, Hounds for Heroes and Pet Blood Bank. The team that raises the most amount will win a day's in-practice imaging training with the BCF in-house vet Kimberly Palgrave, BS BVM&S GPCert(DI) MRCVS.

Andrew Groom from Kruuse said: "This is a great focus to help get fit over the summer months, build team spirit within a practice and enhance a practice's profile locally, as well as raising money for some great causes. There is still room for a few more teams, so we urge practices to not wait any longer and sign a team up now."

For more information visit www.vetcharitychallenge.co.uk, call 01727 859 259 or find it at www.facebook.com/vetcharitychallenge

Ceva Animal Health has announced the launch of Cardalis for the treatment of canine heart failure caused by degenerative valvular heart disease.

Cardalis contains what the company says is a unique combination of benazepril and spironolactone in one tablet which provides "dual blockade" of the RAAS system. 

Benazepril reduces the production of angiotensin II, which causes narrowing of the blood vessels, while spironolactone blocks the harmful effects of aldosterone, which include cardiovascular remodelling and fibrosis.

Cardalis tablets are small, beef flavoured and designed to be administered once a day with food. Each pot contains 30 tablets and there are three sizes available. Ceva says it should be given as part of standard heart failure therapy as soon as clinical signs, such as exercise intolerance, coughing or dyspnoea, appear.

Fraser Broadfoot, small animal product manager at Ceva Animal Health, said: "Through our clinical studies, it has been found that dogs receiving benazepril and spironolactone (compared with benazepril alone) have a better quality of life and, at any one time, are three times less likely to die from heart failure.

"We have also assessed 101 dogs in a field study that were prescribed Cardalis for three months, followed by separate benazepril and spironolactone tablets for two weeks. In the study, 97 per cent of dog owners found Cardalis easier to administer than the two separate tablets and 89 per cent of vets found Cardalis easier to prescribe."

For further information about Cardalis, or to receive marketing materials for the product (which include a waiting room poster and client information booklets),  visit www.ceva.com.uk, or contact the practice support team on 01494 781510.

Zoetis has launched PetDialog and HorseDialog, the only treatment reminder apps for pet and horse owners which veterinary practices can customise with their own branding.

The app is downloadable from the Apple and Android app stores, but is only accessible by inputting a unique practice identity code.

Once the app is unlocked, owners can then input details of any medications their pet is taking and the date its healthcheck / vaccinations are due, after which they'll receive a practice-branded email reminder.

It's a similar idea to Bayer's reminder app released earlier this year, but with the very clever addition of practice branding.

John Toole, Product Manager at Zoetis said: "This is absolutely the right time to launch this app. Smartphone ownership has rapidly increased from 38% to 60% in the last three years and by 2015 it is predicted that 73% of the UK population will own a Smartphone. The use of Smartphones is no longer just the domain of the young - use and ownership is pretty evenly spread among age groups between 24 and 64, with greatest growth among the 44 -74 age group over the past three years. It comes as no surprise that recent market research confirms 57% of UK pet owners own an Android or iOS device.

"Health businesses are the most trusted by UK mobile users when it comes to receiving mobile messages. More than 11 million consumers have opted in to receive mobile messages from health companies, particularly to take advantage of appointment reminders. This form of communication can really boost loyalty where vet practices are concerned, as 74% of users say that mobile messages that had a use or benefit would maintain or enhance their loyalty to that brand.

"PetDialog has been a significant investment for us and with the help of our customers we plan to re-invest in a robust development stream to ensure the app becomes a valuable tool for pet owners and practices alike. To help practices launch and market the app we've developed an extensive bespoke range of marketing support materials from web pages and email templates to practice posters that come alive in the waiting room with augmented reality."

VetSurgeon gave the app a very quick trial. We found registration simple and easy. Clear navigation. Very good first impression.

Except ...

Honestly, whose idea was it that even the most pathologically insane pet owner would possibly, even once in a million years, want to record (and chart) the amount of time they spend hugging their pet. And not just that, but also to categorise their pet-hugging activities according to whether it was 'Morning Cuddles', 'Afternoon Hugs' or 'Evening Snuggles'. Someone at Zoetis' digital agency must have been smoking something very strong when they came up with that one.

Similarly, the ability to record the amount of time spent playing with the dog, breaking it down into specific activities such as: 'Fetch', Tug of War', 'General Playing', is surely targeted at the 0.0000000001% of the pet owning population that really should be getting some sort of professional help.

That said, the overall idea and execution is top notch. Provided Zoetis removes the madder elements of the app at the next upgrade, it'll get 5 stars out of 5. Meantime, it's still highly recommended.

For more information about the app, contact your Zoetis Account Manager

VetNurse Jobs is running a special January Brexit sale until 10:30am on the 18th January, during which all jobs advertised on the site are reduced by 50% to £50 +VAT.

All jobs posted on VetNurse.co.uk are valid for 60 days (double that normally offered elsewhere). They are also emailed automatically to any subscribers with matching search criteria, fed out onto Facebook and the like, and optimised for Google For Jobs.

To see all the latest jobs for veterinary nurses, or to post an advert, login and visit: https://www.vetnurse.co.uk/veterinary-jobs/ 

A veterinary nurse has been reprimanded by the RCVS Disciplinary Committee for removing the heads of two dead stray cats and taking them home. 

The nurse, who admitted the charges against her, successfully applied for anonymity at the outset of the case, on the basis that the shock factor of the removal of the animals' heads could greatly upset members of the public and veterinary staff, leading to a backlash which would present a threat to her safety. 

The Disciplinary Committee heard that the nurse, who was working as a locum, asked a permanent member of staff if she could take a couple of skulls from the strays, because she had a friend who 'cleaned up' dead strays and wildlife and displayed the skulls at home. 

The College’s case was that the nurse’s actions amounted to serious professional misconduct because she failed to afford the dead animals with the respect and dignity they deserved, there was a risk to human health because she failed to comply with biosecurity measures, and her actions had the potential to undermine public confidence in the profession.

Although she admitted that her conduct fell short of what was expected, the nurse countered that her actions were not intended to be disrespectful to the animals, that she was an animal-lover who had three cats of her own, and that her actions were not malicious but misjudged.

Weighing up the case, the Committee found that the aggravating features of her conduct were around biosecurity and abuse of her professional position, while in mitigation it found that there was no financial gain in her actions and that it was a one-off incident.

Kathryn Peaty, chairing the Committee and speaking on its behalf, said: “The respondent’s conduct represented a biosecurity risk.

"Any body part would be in some degree of decomposition.

"As the cats were strays, it was unclear as to whether or not they had been in good health.

"Although the respondent transferred the body parts to her home and kept them in the freezer in cadaver bags, there was a risk that they could leak.

"In short, her actions were not without risk to human or animal health.

“The respondent abused her professional position.

"She had an obligation to treat the cadavers with respect.

"Her professional position gave her access to the cadavers.

"She abused her professional position by severing the cats’ heads and, using a scalpel, body bags and other equipment she pursued an interest of her own, rather than performed the role she was employed to undertake.

"Although she may say that she obtained permission to remove the cats’ heads from a permanent member of staff, she was a Registered Veterinary Nurse and therefore an autonomous professional.

"Whatever permissions she received should not have made her believe she had a licence to act as she did.”

Considering the appropriate sanction, the Committee took into account her relative youth and inexperience, the fact she made open and frank admissions at an early stage, the fact she made efforts to avoid a repetition of the behaviours, the insight she had shown into why her conduct was wrong, and the amount of time that had passed since her conduct relative to the total length of her four-year veterinary nursing career.

The Committee also considered positive character references from fellow veterinary nurses with whom she worked and trained.

Kathryn added: “The Committee considered that a reprimand was the sanction it should impose.

"A reprimand marks the Committee’s view of the respondent’s behaviour, thereby satisfying the public interest.

“The Committee did consider issuing a warning as to future conduct, but it had no concerns that the respondent would fail to follow the Code of Professional Conduct for Veterinary Nurses in the future.

"It therefore rejected a warning as an appropriate alternative.” 

The full findings of the Disciplinary Committee can be found at www.rcvs.org.uk/disciplinary