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MMI seeks to address mental health and wellbeing issues within the veterinary profession, while the Doctors’ Support Network provides peer support for doctors and medical students with mental health concerns.
&me was launched this time last year at the Palace of Westminster at an event sponsored by Kevan Jones MP (Labour, North Durham,) who has spoken about his own experiences with depression.
Overall eleven &me ambassadors have volunteered their own stories with mental ill-health:
A number of &me ambassadors will be taking part in an ‘&me live’ session at BSAVA Congress, from 5-8 April 2018 in Birmingham, providing a short overview of their story before taking questions from the audience. The session will take place from 8.30 to 10.10am on Saturday 7 April and will be open to all those attending Congress.
Lizzie Lockett, RCVS CEO and Mind Matters Director, said: "The feedback our &me ambassadors have received is truly heartening.
"Steve Carter, for example, had both an ex-student and colleague comment on his story thanking him for all he’s done, while a Facebook post about Rob Pettitt reached nearly 25,000 people.
"The campaign highlights how it is possible to recover from mental ill-health and flourish in your career, with the aim of encouraging those at the start of their mental ill-health experience to seek appropriate help, whether that is something profession-specific, such as Vetlife or DSN, or their GP."
Louise Freeman, Co-Chair of the DSN, added: "Many healthcare professionals face similar pressures that can lead to mental ill-health, including long hours, intense pressure, and the nature of the job which requires practitioners to constantly provide care for others, without necessarily recognising the need for self-care at the same time.
"A recurring theme that we’ve seen from these ambassadors’ stories has been that they drew on support from friends and family, and we really hope that this campaign encourages other professionals to seek help if they feel they are struggling."
The campaign is interested in hearing from not only doctors and veterinary surgeons but also nurses, veterinary nurses, dentists, pharmacists and other healthcare professionals who want to open up about their experiences of mental ill-health.
To participate in the campaign, email Dr Louise Freeman on vicechair@dsn.org.uk.
Further information about the ‘&me’ campaign can be found at www.vetmindmatters.org/&me, and a blog by Louise, 'Me and #AndMe', can be found at www.vetmindmatters.org/me-and-andme/.
Ms Bowler faced four sets of charges, each of which contained sub-charges, summarised as follows:
Despite being served with the Notice of Inquiry, Ms Bowler decided not to attend the hearing due to ill-health but was represented by a counsel and solicitors.
The Committee did not find that Ms Bowler was medically unfit to attend on the basis of the medical evidence before it.
The Committee also concluded that it was in the public interest and interests of Ms Bowler to proceed with the hearing in her absence so that it could be concluded in a timely manner.
Ms Bowler’s counsel applied for parts of the hearing to be heard in private on health grounds, which was approved by the Committee.
It was also determined that any parts in the Committee’s decision or hearing that referred to Ms Bowler’s health would be redacted.
At the outset of the hearing, Ms Bowler’s counsel made admissions to five of the sub-charges which the Committee therefore found proven.
She also made some partial admissions in relations to a further 11 sub-charges.
After hearing a wide range of evidence, both written and oral, from Ms Bowler, the College, from clients and from an expert witness, the Committee found all charges proved except for four sub-charges.
On deciding whether the proved charges amounted to serious professional misconduct, the Committee took the following aggravating factors into account.
In mitigation:
In all, the Committee decided that the seriousness of the misconduct meant that a sanction was necessary to meet the public interest.
When deciding on whether to issue a reprimand with or without a warning, the Committee once again decided that the misconduct was too serious to allow for this.
It also decided that a reprimand and/or warning was not sufficient to protect animals and the wider public interest.
It then went onto consider whether a sanction of ‘suspension’ was sufficient but noted that it did not have enough evidence to show that Ms Bowler had shown significant insight to continue to practise unrestricted in the future.
The Committee eventually concluded that Ms Bowler’s conduct was incompatible with remaining on the Register.
Neil Slater, chairing the Disciplinary Committee and speaking on its behalf, said: “The Committee decided that the broad range of Ms Bowler’s misconduct which had spanned three years and eight months and involving injury or risk of injury to 18 animals, was incompatible with remaining on the Register and the public interest required removal from the Register even when all of Ms Bowler’s mitigation was taken into account.
“The Committee decided that it did not have sufficient evidence overall on Ms Bowler’s insight, current competence and future risk to persuade it that the lesser sanction of suspension was appropriate in this case.
“Although Ms Bowler had shown some insight, the Committee decided that she would need to have provided detailed evidence about her current practice before it could decide that she no longer represented a risk to animals in the future.
“The Committee therefore concluded that ‘removal from the Register’ was the appropriate and proportionate sanction because there had been a serious departure from professional standards, a reckless disregard for professional standards, multiple cases involving harm or risk of harm to animals and because, in Ms Bowler’s absence, it had been difficult to unravel whether she had an attitudinal problem.
“These were all factors in the Disciplinary Committee Sanctions Guidance that indicated that a sanction of removal was the appropriate sanction and, in the Committee’s decision, removal from the Register was the only sanction which would meet the public interest.
"It concluded that a lesser sanction would undermine public confidence in the profession and in the regulatory process.”
https://www.rcvs.org.uk/concerns/disciplinary-hearings
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!
Earlier this month, the government had exempted veterinary surgeries from the requirement to close their doors during the pandemic. Strictly speaking, the exemption meant that practices could carry on offering the same level of service as before, provided they followed further government guidelines on social distancing.
However, the College then advised that non-essential treatments should not be carried out until further notice, and that animals should only be seen in emergency, or if their health was likely to deteriorate as a result of inaction.
This included vaccination, where RCVS advice stated that whilst routine vaccinations were considered not urgent, there "may be scenarios where, in your professional judgement, vaccines are being given to reduce a real and imminent risk of disease; this includes in the face of an animal disease outbreak, or in a scenario where part of a vaccine course has been given and the animal may be exposed to the disease."
The updated College guidelines, issued last Thursday evening, appeared little changed, except to say that its advice concerning vaccinations is under review. Meanwhile, its new flowchart gives a very clear framework for veterinary professionals to work within, essentially leaving it to your own professional judgement to weigh up the risks.
However, the BVA went further, declaring amongst other things, that:
Vaccinations – we are now recommending that primary vaccinations and year 1 boosters in dogs and cats go ahead due to the increased risk of disease outbreak over a longer period of time, and annual leptospirosis vaccination due to the zoonotic risk. If additional component of the core vaccine is due at the same time, it should also be administered. In addition, we’re recommending rabbit vaccinations go ahead due to the seasonal disease risks. Rabies vaccinations should be carried out if required for certification reasons
.... leading to an outcry that the BVA's advice appeared to be being relaxed at precisely the point when the government is imploring the public to stay at home, and that:
To add further fuel to the flames, the British Small Animal Veterinary Association then issued a statement to the effect that it had not been consulted during the preparation of the new BVA guidelines, which BVA past President Robin Hargreaves felt was so economical with the truth that he resigned his BSAVA membership on the spot.
COMMENTAt the end of it all, there is but one simple truth for every veterinary surgeon who is working in these difficult times, and it is this: The government and the RCVS guidance gives you the freedom to exercise your professional judgement concerning whether or not an animal needs to be seen for whatever reason. Provided you can explain why you reasonably concluded that an animal should or should not be seen, that is all that matters. It trumps everything else.
This whole farago has highlighted a number of important issues in the profession, starting with the social media conspiracy theories that the new guidance came after pressure from corporate practices when as far as I can tell, it appears to have been driven by a genuine concern that that failure to vaccinate could cause significant welfare issues in the future.
That seems a reasonable argument, and very much in line with the College advice. But that in turn raises a far bigger question, which is what on earth the BVA (a voluntary membership organisation) was doing issuing what appeared to be instructions ostensibly for all members of the profession. Notwithstanding the fact that BVA recommendations have no legal weight, having all these chefs running around with different recipe books is itself a recipe for muddled communications and confusion over leadership.
In turn, that raises the even bigger question of what the BVA's role should be. Should it be snuggling up in bed with the RCVS, issuing joint edicts? Or should it instead be holding the College to account, challenging its decisions and demanding clarification where clarification is necessary. I would argue the latter. In this situation, the ONLY organisation issuing guidelines about vaccinations for practising vets should be the regulator. And it is the role of the BVA to challenge those guidelines if necessary, or to demand clarification.
Which leads me on to the next thing, which is that increasingly, members of the profession seem to demand explicit rules or guidelines to operate within. There are lots of hypotheses for why this might be true. Perhaps because we live in a more (or seemingly more) litigious world and veterinary professionals like the reassurance rules provide. Perhaps it is because the younger cohort of vets lack the self-confidence needed for decision-making. Perhaps corporatisation has a part to play, in that employees of larger organisations tend to play more by the rules. Or perhaps it is a consequence of the growth in the 'refer everything’ culture which means vets take fewer clinical risks.
Whatever the reason, it seems clear that in some cases, the RCVS tack of "you're a professional, decide for yourself" is perfectly reasonable, whereas on other occasions, such as Schedule 3, more explicit guidelines are demonstrably necessary. Once again, surely the role of the BVA as the "Voice of the profession” is not to issue its own advice, but to press the College for more explicit guidelines as necessary.
Lastly, there is the role of Facebook in all of this. Quite obviously vets are no more immune to conspiracy theories than members of the public who think that coronavirus is spread by 5G telephone masts. Sadly, the truth is usually far less exciting. However, the problem at the moment is that the growth in social media and Facebook groups has left the regulator and the representative associations on the back foot, such that it is often left to individuals from those organisations who 'happen to come across OK online' (rather than having any properly defined role) to firefight.
Photo: https://www.scientificanimations.com/wiki-images/
The Royal College of Veterinary Surgeons is calling for comment on a draft Performance Protocol, which aims to manage proportionately any justified concerns about the professional performance of veterinary surgeons and registered veterinary nurses.
The RCVS's Preliminary Investigation and Advisory Committees have been working together to develop a new protocol setting out the way in which the College will respond to ongoing performance-related concerns. There is an expectation that veterinary surgeons and RVNs are already regularly reviewing their clinical work in the workplace. This will be reinforced by the new principles-based Code of Professional Conduct, currently being finalised, which is likely to require clinical governance to be part of professional practice for veterinary surgeons and RVNs.
According to the College, the draft protocol is intended to formalise and build on the way it already manages ongoing serious performance-related concerns. It introduces new measures, including supervision and undertakings, to seek to ensure that veterinary surgeons and RVNs take reasonable steps to address any serious performance concerns. This will bring the RCVS into line with other professional regulators and enable a tailored and proportionate response to these cases to protect the welfare of animals and the public interest. The College's current system of offering advice to veterinary surgeons and RVNs will remain for complaints which are closed, because there is no indication of serious professional misconduct.
The College says that according to independent legal advice, such an approach is appropriate and necessary in order for it to fulfil its regulatory responsibilities. The draft performance protocol follows similar legal advice that supported the implementation of the RCVS Health Protocol, and both protocols clarify the College's parallel jurisdiction relating to health and performance-related issues.
RCVS President Jerry Davies said: "When veterinary surgeons and registered veterinary nurses are unable to deal with performance-related concerns, it is important that we are able to provide a supportive framework to oversee remedial steps that are designed to address those concerns and encourage professional development. This is best achieved outside a Disciplinary Committee hearing, if at all possible".
The approved draft protocol is now open for public consultation, and may be found at www.rcvs.org.uk/performance. All comments on the draft should be emailed to Simon Wiklund, Advisory Manager at s.wiklund@rcvs.org.uk by 13 January 2012, with 'Performance Protocol' added to the subject heading.
The feedback received from the consultation will be considered by the Preliminary Investigation and Advisory Committees in January 2012, before being submitted to RCVS Council for approval in March.
The College says it hopes that a performance protocol will form part of the supporting guidance to the new RCVS Codes of Professional Conduct for both veterinary surgeons and registered veterinary nurses.
The programme centres on the theme “The future RVN: people, practice and technology”.
Sessions will examine how developments across veterinary healthcare may influence the training and role of veterinary nurses.
Topics include team-based healthcare and contextualised care, focusing on collaborative practice and the complexity of real-world clinical environments.
An update on legislation and regulation affecting veterinary nursing practice and education is also included.
A panel discussion will explore technology-enabled practice, including artificial intelligence, digital innovation, paperless practice and entrepreneurial developments within veterinary nursing.
Delegates can also attend one of two workshops covering practical assessment approaches or the future scope of veterinary nurse practice.
Shirley Gibbins, Veterinary Nursing Qualifications Lead at the RCVS, said: “The day itself is highly interactive and serves as a perfect opportunity for VN educators to come together, explore emerging trends, share perspectives and reflect on how education and training can respond to a changing professional landscape.
“Whether you’re involved in curriculum delivery, assessment, quality assurance or programme leadership we would love for you to join us.”
Tickets cost £60 per person and include lunch and refreshments.
https://www.eventbrite.co.uk/e/vn-educators-conference-the-future-rvn-people-practice-and-technology-tickets-1981441511901
In next year's election, there are two places on Council for elected veterinary nurses, with successful candidates serving three year terms.
The nomination period runs until 5pm on Friday 31 January 2020. In order to stand, candidates need to complete a nomination form, submit a short biography and personal statement and supply a high resolution digital photo.
Each candidate also needs to have two nominators who need to be veterinary nurses who are on the RCVS Register but are not current RCVS Council members.
The College says nominations will be particularly welcome for VN Council as, due to governance changes, no election took place in 2018 and there was also no election in 2019, because only two candidates stood for the two available places.
Racheal Marshall, Chair of VN Council, said: "Although we are delighted with the two VN Council members who came on board this year, I think all would agree that it was a shame that there was no opportunity for the profession to exercise their democratic right and cast a vote for their preferred candidates.
"Being a member of VN Council and, latterly, its Chair has been a professional highlight for me – I have helped shape recommendations for how we can take the profession forward through the VN Futures project, have played a part in developing the postgraduate Certificates in Advanced Veterinary Nursing and have welcomed many new veterinary nurses to the Register by taking them through their professional declarations.
"We know that veterinary nurses sometimes feel that they struggle to be seen and heard – being a member of VN Council who can shape policy on education and professional conduct and attend events as an ambassador for the profession all helps give veterinary nursing the voice it deserves. So please consider standing for VN Council and I am very happy to talk to people about what it involves and how to fit it around your work and life."
Veterinary nurses who wish to find out more about becoming a candidate for VN Council can arrange an informal conversation with Racheal by contacting Annette Amato, VN Council Secretary, on a.amato@rcvs.org.uk
Eleanor Ferguson, RCVS Registrar and Returning Officer said: "As always, we would encourage those who are interested in having their say in some of the key debates in the regulatory sphere, such as our under care review, our policies around the impact of Brexit and our vision for new veterinary legislation, to become a candidate.
"RCVS Council is at its best when it encompasses a broad range of perspectives, experiences and knowledge, and so we encourage people from all areas of veterinary life and all levels of experience to put themselves forward and share their expertise and insight."
Nomination forms, guidance notes and frequently asked questions for prospective RCVS VN Council candidates can be found at www.rcvs.org.uk/vncouncil20.
Prospective candidates for Council are welcome to contact the Registrar, Eleanor Ferguson (e.ferguson@rcvs.org.uk) and the RCVS CEO, Lizzie Lockett (l.lockett@rcvs.org.uk) for more information about the role of the College and/or Council.
RCVS Council will also be holding its next public meeting on Thursday 23 January 2020, prior to the closure date for Council candidate nominations. Prospective candidates are welcome to attend the Council meeting as an observer. Contact Dawn Wiggins, RCVS Council Secretary, on d.wiggins@rcvs.org.uk if you wish to attend.
The 2009 RCVS Continuing Professional Development Record Cards have been sent to all practising vets and Registered Veterinary Nurses.
Undertaking and recording Continuous Professional Development (CPD) is a mandatory professional requirement for these vets and RVNs. Vets must average at least 35 hours of CPD per year and RVNs 15 hours, although many will do far more.
The RCVS can ask to see CPD records - and they may be checked during practice inspections as part of the Practice Standards Scheme. For newly-qualified veterinary surgeons, completing the Professional Development Phase also fulfils the CPD requirements in their first year of practice.
Jill Nute, President of the RCVS, said: "CPD is about maintaining professional competence. Vets and RVNs are expected to make continuous improvements in their knowledge and skills, which will have benefits for their patients and clients, their own development and the profession at large. Undertaking CPD allows vets and RVNs to demonstrate their commitment to maintaining the highest professional standards."
As professionals, vets and RVNs are expected to evaluate what knowledge and skills they need to develop, and how they will do this. This may include activities such as going to particular case-conferences or asking for some in-house training. Getting together with other practices to organise training sessions or secondments or finding a mentor can also be useful.
Personal study - documented in a learning diary detailing the aims of the study, what was studied and the outcomes, for example, a change made to a practice protocol - can also be used. There is no limit on properly documented study, but vets cannot count more than 10 hours, and veterinary nurses five hours, each year of undocumented study.
All CPD activity should be systematically planned to meet identified professional needs, and clear records must be kept of what has been done.
Further information about CPD requirements for veterinary surgeons and Registered Veterinary Nurses can be found on the back of the CPD Record Card, and at RCVSonline (www.rcvs.org.uk).
Dr Botes faced a total of nine charges against him, relating to performing (or recommending) inappropriate total hip replacements on five dogs without adequate investigation and without getting informed consent from the owners.
One of the charges also related to a failure to keep adequate, clear and detailed clinical records in relation to the five dogs.
Dr Botes denied the first two charges which were later dismissed because the owner did not attend the hearing and counsels agreed that it would not be in the public interest to pursue them.
Dr Botes admitted the other seven charges and that they amounted to serious professional misconduct, and they were therefore found proven by the Committee.
In considering whether the charges amounted to serious professional misconduct, the Committee considered an expert report from Professor John Innes, RCVS Specialist in Small Animal Surgery (Orthopaedics) and Mr Midgley, RCVS Advanced Practitioner (Small Animal Orthopaedics).
Ian Arundale, Chair of the Committee, said: “In coming to its decisions, the Committee took into account Professor Innes’ opinions that it was not reasonable for Dr Botes to have carried out the THR without sufficient investigation into Kilo’s pain; that the THR undertaken in respect of Sora was not in the animal’s best interests; and that it was ‘entirely unnecessary’ to recommend the THR in respect of Penny.
"In addition, the Committee has found that both THRs performed in respect of Daisy were not in her best interests.
"Thus, in the Committee’s view, Dr Botes’ actions and omissions did not ensure the animals’ health and welfare.”
The Committee took into account that the THRs in question were a source of financial gain, that Dr Botes’ conduct was repeated over a considerable period of time and that he was in an increased position of trust and responsibility because of perceived expertise in small animal orthopaedics and its education.
However, the Committee took into account, as a mitigating factor, that Dr Botes has indicated some insight into some aspects of the charges in his written communications to the College, in his witness statement dated 29 December 2021, and in his admissions at the start of this inquiry.
The Committee then considered what would be an appropriate and proportionate sanction, hearing from several character witnesses including Dr Midgely, who was put forward as Dr Botes’ proposed supervisor if the committee agreed to a postponement with undertakings.
When making their decision, the Committee took into account the fact that Dr Botes had been suspended from the Register in 2008 for six months for serious professional misconduct over the care of a dog that had been involved in a road traffic accident.
The Committee considered a postponement of judgment with undertakings, which was submitted by Dr Botes’ counsel.
However, the Committee took the view that a postponement would not be appropriate because the failings were not in limited aspects of practice but were wide-ranging, covering the fundamental requirements of any veterinary surgeon.
In the Committee’s view, this would mean nothing less than direct supervision, where Dr Botes’ practice was directly monitored on a day-to-day basis would be sufficient to protect animals, clients, and to uphold the wider public interest.
It would be impracticable to formulate undertakings capable of effectively addressing these issues.
The Committee also noted that the disgraceful conduct was serious and there was a pattern of sustained and persistent misconduct.
The Committee therefore did not believe that no further action, a reprimand or a warning were appropriate or proportionate outcomes.
The Committee also considered whether suspension was appropriate but concluded that there was a real risk of repetition of the behaviours outlined in the charges, and so the Committee was unable to conclude that Dr Botes would be fit to return to practice after a period of suspension.
The Committee therefore decided to direct that Dr Botes should be removed from the Register indefinitely.
In coming to this decision, the Committee carefully applied the principle of proportionality and took into account the impact of such a sanction on Dr Botes both professionally and financially, and took into account his witness statement in this regard.
Ian Arundale added: “In light of the gravity of the conduct, and all of the factors taken into account, any lesser sanction would lack a deterrent effect and would undermine public confidence in the profession and the regulatory process.
"Removal was the only appropriate and proportionate sanction.”
Dr Botes has 28 days from being notified of his removal from the Register to lodge an appeal with the Privy Council.
The Committee’s full findings can be viewed at www.rcvs.org.uk/disciplinary
In previous years, candidates were only asked to provide manifestos, which often contained information that wasn't especially relevant to whether or not they should be elected to Council.
Now, they are asked to share their reasons for wanting to be elected, what they can bring to Council and what experience they have.
This year’s candidates are:
Bethan Pinhey RVNHannah Welsman RVNLauren Whittaker RVN
The full biographies and election statements for each candidate are available to read at: https://www.rcvs.org.uk/vnvote25
The two candidates who get the most votes will take up their three-year terms on RCVS Council at the College’s Annual General Meeting on Friday 4 July 2025.
Simon Wiklund, Assistant Registrar and Returning Officer for both elections, said: “We are glad to see such a large number of veterinary professionals putting themselves forward as candidates for this year’s elections.
"It is worth noting that any future governance changes, including RCVS and VN Councils becoming all-appointed bodies, are contingent on new legislation and, until that happens, we will continue to hold our annual elections.
“You may have also noticed some differences with this year’s elections, particularly in terms of the candidate statements.
"This is thanks to a change to our election scheme, which provides greater flexibility about how we run our elections, and the information that we can ask the candidates to submit.
“This means that, rather than asking candidates for a broad manifesto statement, we’ve asked them to answer key questions that are relevant to the role of a Council member, including what skills and experiences they can bring to the table.”
Ahead of the elections, RCVS will be running its ‘Quiz the candidates’ initiative in which veterinary surgeons can submit questions to the candidates standing in their respective elections, in order to better understand them and their views.
However, due to the additional information now included in each of their statements, this year candidates will only answer one question of their choice each.
Before submitting questions to the candidates, please note the RCVS will only accept one question per person. Offensive, defamatory and inaccurate questions will be rejected by the Returning Officer and not be passed on to candidates.
Veterinary nurses can submit a question to the VN Council candidates by emailing vnvote25@rcvs.org.uk.
Developed in partnership with the Veterinary Client Mediation Service (VCMS), the course uses practical examples based on real-life experiences.
The course shows how to assess complaints from a client’s perspective and how building client relationships can help defuse complaints.
Jennie Jones, Head of VCMS, said: "Leveraging insights from the VCMS and involving our entire team with its production has enabled us to develop highly effective materials that ensure veterinary professionals are well-equipped to manage complaints."
The course takes one hour to complete.
academy.rcvs.org.uk
The grant has been awarded to Dr Faye Didymus and Dr Jackie Hargreaves (pictured) from Leeds Beckett University who aim to address a potential lack of understanding surrounding the importance of mental health education in the learning paths of student veterinary nurses.
This will be done through a scoping review of mental health education during student veterinary nursing curricula.
The review will be supplemented by interviews with tutors, veterinary nurse students and qualified veterinary nurses to understand their experiences of and levels of exposure to mental health education.
It is hoped this research will culminate in a set of evidence-based recommendations for how mental health education for student veterinary nurses could be enhanced.
Dr Faye Didymus said: “Maintaining good mental health is vital for job satisfaction, retention, and performance, and integrating mental health education into veterinary nursing courses is one way that veterinary nurse mental health can be supported, as it allows people to develop essential skills that will benefit their lives beyond education.”
“However, little is known about what mental health education is provided across veterinary nursing diplomas and degrees or if there is a consistent approach.
"Throughout the research, we aim to build a clearer picture of the current provision, so we can create evidence-based recommendations for the optimisation of veterinary nursing education.”
Mind Matters Initiative Manager, Lisa Quigley, said: “Much of the research into veterinary mental health has so far been centred around veterinary surgeons so we were keen to fund a veterinary nurse focussed project to help close that knowledge gap.
"The veterinary field encompasses the entire veterinary team, and we cannot afford to overlook a group that makes up much of the working veterinary population and who are vital for the functioning of the sector. It is essential that we support our veterinary nurses throughout their careers and provide them with the knowledge and tools to look after their own mental wellbeing from the outset.
“Research plays a major role in this, and we are delighted to be funding a fully nurse-based project.”
https://vetmindmatters.org/mind-matters-mental-health-research-symposium-2023.
The results, in order of number of votes, are:
Elected: Susan Paterson – 3,976 votes
Elected: Mandisa Greene – 3,819 votes
Elected: Neil Smith – 3,544 votes
John Innes – 3,502 votes
David Catlow – 3,310 votes
Matthew Plumtree – 2,677 votes
Iain Richards – 2,635 votes
Karlien Heyrman – 2,487 votes
John Davies – 580 votes
Thomas Lonsdale – 542 votes
Due to the fact that a Legislative Reform Order (LRO) that amends the College’s governance has completed its passage through the House of Commons and House of Lords and is expected to be signed off by the relevant Minister to bring it into law, only the first three candidates are expected to take up their posts on Council at RCVS Day on 13 July 2018.
Eleanor Ferguson, RCVS Registrar and Returning Officer for the election, said: "I would like to thank all the candidates who stood for Council this year and would like to, in particular, congratulate Susan, Mandisa and Neil for being re-elected to RCVS Council.
"The LRO that is likely to be signed off in due course will reconstitute the makeup of Council – with greater lay and veterinary nursing input – and will also reduce the overall size of Council, including the number of elected members. Because of this only the first three – as opposed to the first six under previous rules – candidates are likely to be taking up a four-year term at RCVS Day 2018. Our commiserations go out to all the unsuccessful candidates, especially in this unusual transitional year, and we thank them for their participation in this year’s election."
The results of the election will be formally declared at this year’s RCVS Day – the College’s Annual General Meeting and awards ceremony – which takes place at the Royal Institute of British Architects on Friday 13 July 2018.
The case against Jose Ignacio Messa MRCVS related to two heads of charge against him.
The first charge was that, on 13th September 2015, Mr Messa failed to provide adequate and appropriate care to Barney, a border collie. The second charge was that on 14th September 2015 Mr Messa failed to ensure adequate and appropriate on-going care for Barney after his examination of him, including failing to take sufficient steps to ensure that Barney was referred urgently to the care of a referral practice and failing to ensure there were adequate arrangements in place for his ongoing care.
Barney was presented to the Basingstoke practice where Mr Messa was employed having suffered a severe 'stick injury' to his jaw on 12th September.
The Committee heard that, on 13th September, Mr Messa re-examined Barney, administered medication and then discharged him to be cared for at home by his owners. During the examination the owners alerted Mr Messa to the condition of the skin on Barney’s neck, but the Committee heard Mr Messa had felt the area and reassured them it was not something to be concerned about.
The Committee heard that at some point on 13th September, after he was discharged, Barney developed a foetid smell from his mouth caused by an infection and the next day his owners went back to the practice because Barney’s condition had deteriorated – he was unable to walk and had laboured breathing.
On 14th September Mr Messa admitted and sedated Barney and examined him again, noting a hole in the side of his throat that was infected. He recommended referring Barney to a referral practice for further treatment, which was agreed by his owners.
The Committee heard that the referral practice was contacted by a veterinary nurse at the practice and that an appointment for 9am on 15th September 2015 was booked directly with the owner. It also heard that, during his time at Mr Messa’s practice, Barney did not receive intravenous fluids or any further antibiotics.
Barney’s owners said they met with Mr Messa again at around 5pm on 14th September when they came to collect Barney, this was disputed by Mr Messa, and the Committee were not satisfied so as to be sure that it had been Mr Messa who had met the owners and discharged Barney although the Committee found that all the witnesses had been honest and reliable.
Barney was admitted to the referral practice on 15th September but, as a result of sepsis, he suffered a cardiac arrest and died at 10.30pm.
In respect of the first charge the Committee concluded that, on 13th September, Mr Messa made only a rudimentary examination of Barney, and the absence of such basic clinical examination of the temperature, the respiration rate and the pulse of Barney was a failure on the part of Mr Messa and that, furthermore, he did not choose the best course of antibiotic treatment for the wound and infection.
In respect of the second charge Mr Messa admitted that he did not provide fluid therapy to Barney on 14th September before he was discharged.
With reference to the remaining aspects of the charge the Committee took into account the Code of Professional Conduct, particularly in respect of the need for veterinary surgeons to refer cases responsibly and the Code’s supporting guidance on referrals.
The Committee determined that, having delegated the arrangements of the referral to a veterinary nurse, Mr Messa made no attempts to follow up and ensure it was a same-day appointment when this would have better suited the severity of Barney’s condition. The Committee found that he was unaware of Barney’s location or of the time of the appointment and did not make provision for antibiotic or fluid therapy.
Having found the majority of the charges against Mr Messa proven, the Committee then considered whether this amounted to serious professional misconduct.
Disciplinary Committee member Stuart Drummond, who was chairing the Committee and speaking on its behalf, said: "In the light of the facts found proved and considering that disgraceful conduct in a professional respect is that which is conduct falling far below that expected of a veterinary surgeon, the Committee had concluded that the heads of charge, when taken individually, or collectively, do fall below the standard expected.
"However, as a matter of judgement, the Committee did not conclude that Mr Messa’s conduct fell far below the requisite standard and therefore did not amount of disgraceful conduct in a professional respect.
"Whilst the Committee did not find Mr Messa’s actions fell far below the requisite standard, there were concerns expressed about several aspects of this case. There were a number of missed opportunities which occurred; in particular the Committee notes the failure of the care plan and to take adequate steps to ensure that the referral process has been timeously effected."
The sessions will allow members of the profession to find out about upcoming College projects and put questions to the RCVS Officer Team, RCVS Council members and senior staff, in a friendly, informal atmosphere.
The first event is taking place at the Hilton Glasgow on William Street at 6:30pm, where there'll be supper and drinks before the main event at 7:30pm, when RCVS President Melissa Donald, RCVS Treasurer Niall Connell, RCVS Senior Vice-President Kate Richards, Junior Vice-President Sue Paterson, VN Council Chair Matthew Rendle, RCVS Registrar Eleanor Ferguson and RCVS CEO Lizzie Lockett will update everyone on College activities and take questions.
The College says that the topics for discussion will be up to the audience but are likely to include workforce issues, the review of RCVS guidance on under care, proposals for legislative reform, VetGDP and the future of extra-mural studies.
Melissa said: “In my opening speech as RCVS President I said that one of the key missions of my presidential year was to talk – and especially listen – to as many members of the professions as I possibly can.
“Relaunching our question time programme after a hiatus will give me the opportunity to do exactly this, as well as giving members of the professions that all-important opportunity to put their questions and concerns directly to us.
"We might not be able to address every problem, but these events give an excellent opportunity for vets and nurses to raise issues, forge connections with their peers and work together to find solutions.
“I hope that many of you will be able to come to our first in-person event in Glasgow but we will also be holding these question times virtually in the future for those people who may struggle to make it to these evening events.
"Rest assured – if you want to be heard, we will find a way to listen.”
The next in-person event is due to take place in Nottingham in January 2023 while the first virtual question time will take place in November 2022.
To register for the Glasgow event visit: tinyurl.com/22pem3d6
Dr Radev faced three charges concerning his treatment of an American Bulldog in 2021.
The first charge, which contained a number of sub-charges, was that he failed to provide appropriate and adequate care to the animal.
The second was that he failed to keep adequate records.
The final charge was that his failure to keep records was misleading and dishonest.
At the outset of the hearing Dr Radev admitted that, having recognised free fluid in the dog’s abdomen, he failed to take adequate and appropriate action and failed to aspirate the dog’s abdomen with regards to the possibility of it having septic peritonitis.
He also admitted writing the clinical notes approximately two months after the event.
After considering and rejecting an application by the RCVS to amend and withdraw elements of the first charge, the Committee then considered each of the remaining sub-charges in turn.
Sub-charge 1(a) was that Dr Radev repeatedly administered meloxicam to the dog when it had recently undergone intestinal surgery and had a recent history of vomiting.
The Committee found that this was not proven.
Dr Radev said it had been administered just once and the Committee was not satisfied so as to be sure that it was repeatedly administered.
Sub-charge 1(b) (i) was that Dr Radev failed to recognise free fluid in the dog’s abdomen as shown on an ultrasound scan.
The Committee found this not proven.
Sub-charge 1(c) (i) was that Dr Radev failed to recognise the possibility of septic peritonitis in the dog.
Sub-charge 1(e) was that Dr Radev failed to provide a full medical history when referring the dog to a different practice.
The Committee found the charge not proven.
Regarding charge 2 (ii), that Dr Radev had failed to include in clinical records a reference to the colonotomy surgery, the Committee found this charge not proven as it had been provided with clinical records disproving this charge.
Finally, regarding both aspects of charge 3, namely that Dr Radev had acted misleadingly and dishonesty, the Committee found this not proven.
The Committee then considered whether the charges that Dr Radev had admitted amounted to gross misconduct in a professional respect.
In all cases it found that, while Dr Radev’s conduct had fallen below what was expected of veterinary professionals, it did not fall so far below as to constitute serious professional misconduct.
www.rcvs.org.uk/disciplinary
The proposal seems to have its roots in the First Rate Regulator initiative announced by Nick Stace in November 2012. As part of the initiative, the College commissioned Sally Williams and Associates to conduct research amongst stakeholders and report back with recommendations for being a first rate regulator.
One of those recommendations was to move to the civil standard of proof (page 33/34 here). There is no stated rationale for this recommendation, other than: "The majority of other professional regulators have moved to the civil standard of proof".
Nevertheless, the recommendation then found its way into the RCVS 2017-2019 Strategic Plan.
The proposal was then mentioned in the published summary of the Legislation Working Party's meeting in December 2017:
"In considering reform to the disciplinary process, the Registrar noted that the RCVS is one of the only regulators (and the only healthcare-based regulator) still using the criminal standard of proof (‘beyond all reasonable doubt’) when determining the facts of a case. Most other regulators used the civil standard of proof (‘on the balance of probabilities’) when making their determinations. Consideration of moving to the civil standard has also been carried over from the College’s previous Strategic Plan and the Registrar agreed to review the last six months’ cases to assess what the likely outcome of those cases would have been under the civil standard, and the cost of change. The Working Party also decided to contact other regulators about their disciplinary processes, in order to gather information about their experiences of what does and does not work, both for long-standing issues and new reforms."
The proposal then resurfaced last week in the Veterinary Record, which reported that the College is in 'advanced discussions' about adopting the lower standard (Standard of Proof for disciplinaries could change).
The College has now issued a statement to VetNurse.co.uk as follows:
"The Royal College of Veterinary Surgeons (RCVS) is currently very much in the minority of regulators still using the criminal standard of proof ('beyond all reasonable doubt') in its disciplinary proceedings, rather than the civil standard of proof ('on the balance of probabilities').
"By comparison, all nine of the healthcare regulators in the human field (as overseen by the Professional Standards Authority) have moved to the civil standard, as have other regulators such as the Bar Standards Board and the Solicitors Regulation Authority.
"In our last two strategic plans we have committed to considering whether or not the RCVS should change the standard of proof in line with other regulators and these discussions have been taking place as part of the ongoing deliberations around legislative reform.
"A change to the standard of proof would require an amendment of our 2004 Procedure and Evidence Rules via the Privy Council rather than new primary legislation, but we would consult with the profession before any such changes were made and, at present, this matter has not been put before RCVS Council for a decision."
So, as it stands now, no evidence has yet been presented to the profession which supports the need for - or benefits of - a change to the standard of proof required in disciplinaries. The idea that it should be done simply because 'that's what the other regulators are doing' does not hold water. The veterinary profession is unique. According to the College's own research, it enjoys a remarkably high level of trust amongst the public. But at the same time, it also suffers one of the highest suicide rates.
Clearly Council will need to reflect extremely carefully on whether the members of such a widely trusted profession should face an even greater threat of losing their career, particularly when they seem to be at such a risk of vexatious complaints, fear of a disciplinary is already so high, and the consequences of this change on mental health in the profession could be so profound.
It may even be true to say that lives could depend on this decision.
The model for the forecast was developed by the College with the Institute of Employment Studies using data from the RCVS Registers, the 2019 and 2024 Surveys of the Professions, Office for National Statistics data for projected economic growth and the PDSA’s Animal Wellbeing (PAW) Reports.
However, the model does not take account of the impact of the increasing costs of veterinary care on pet ownership trends, the full effect of which may not yet have been felt.
The main predictions of the model are:
Lizzie Lockett, RCVS Chief Executive Officer, said: “In 2021, there were clear concerns about there being a workforce crisis within the veterinary professions, and while that certainly seemed to be the case, and is likely to continue to be so in the short-term, according to this model the future picture for the professions looks much better in most areas of veterinary practice.
“We are aware that there may be some concerns about the implications of the model, particularly concerning the potential oversupply of veterinary nurses.
"While we stand by the robustness of the data, demography is not destiny, and with the planned enhancement of the veterinary nurse role, and the likelihood of suppressed demand due to prior shortages, it is likely that the number of veterinary nursing roles will expand to encompass the number of veterinary nurses available to work in it.
“Finally, we are aware that there are also some limitations to the model in its current form, for example, in terms of regional data.
"This is a work in progress, and we will continue to update and improve the model as and when new data allows.”
The workforce modelling report is available to download from www.rcvs.org.uk/publications
The consultation invited members of the professions to explain how they currently understand and interpret Schedule 3 in practice, how it could be clarified and how it might be amended to bolster the veterinary nursing profession.
11,625 people responded to the consultation, the highest number that has ever responded to an RCVS consultation. 6,873 were veterinary nurses (around 35% of the profession and including 1,665 student veterinary nurses) and 4,752 were veterinary surgeons (around 21% of the profession).
The report on the consultation, which is published today by the Institute for Employment Studies, found that 92% of veterinary nurses and 71% of veterinary surgeons think veterinary nurses should be able to undertake additional areas of work.
However, neither vets nor nurses seem to have an especially good understanding of the current scope of Schedule 3 and how it applies in practice, rating their personal understanding at 5.6 and 6.7 out of 10 respectively.
When asked what prevented the full utilisation of veterinary nurses, the majority of both vet and vet nurse respondents highlighted a lack of understanding of what tasks can be delegated under Schedule 3, with around 60% of veterinary surgeons also admitting that they are not good at delegating.
61% of veterinary nurses and 50% of veterinary surgeons thought that the RCVS gives sufficient support and advice about Schedule 3, though the relatively poor level of understanding amongst veterinary surgeons in particular suggests more needs to be done.
In corresponding comments both veterinary nurses and veterinary surgeons said they would like more clarity, especially around 'grey areas' such as the meaning of the term 'minor surgery', as well as further communication from the College about Schedule 3 and for more training for veterinary nurses to ensure they have the competence and the confidence to carry out delegated procedures.
Liz Cox, Chair of RCVS Veterinary Nurses Council, said: "Thank you to all those who responded to the consultation in such large numbers and who shared their views on this topic. The consultation grew out of the government’s suggestion that we review Schedule 3 as a means of bolstering the VN profession, and from the VN Futures project last year, when Schedule 3 was identified as an area where there could be some additional work to clarify the rules around delegation to veterinary nurses.
"There was a clear consensus that veterinary nurses could do more in their role and under Schedule 3 and so we will be feeding the findings back to the RCVS Legislation Working Party, which will be looking, in the round, at possible changes to the framework of veterinary legislation, including how it applies to veterinary nurses and other paraprofessionals.
"In terms of the understanding of Schedule 3 and how it applies in practice it is clear that we need to do some further work to clarify the rules and develop guidance to assist both veterinary nurses and veterinary surgeons in exercising their professional judgement in respect to delegation, for example, through case studies and other examples."
Looking at the tasks currently performed by veterinary nurses, the survey found the five most commonly performed are: clinical cleaning (92%), administration of medicines by subcutaneous injection (91%), administration of medication (90%), monitoring of anaesthesia (86.5%) and administration of medicines by intramuscular injection (86%).
The consultation also found that the majority of veterinary nurses are involved in clinics aimed at educating animal owners on various different aspects of animal health and welfare. The most common include puppy/kitten care (66.5% of respondents), nutrition (65% of respondents), general check-ups (62.5% of respondents) and dental care clinics (57% of respondents).
Post-survey interviews with 10 veterinary nurses and 10 veterinary surgeons found a number of recurring themes, including: limited career paths for veterinary nurses; poor pay for VNs relative to their training and complexity of work; lack of recognition and appreciation for the VN role; enthusiasm for advanced practitioner and specialist status for VNs; and difficulty recruiting experienced VNs.
The College says the results of the consultation will now be considered by the RCVS Schedule 3 and Legislation Working Parties, which are reviewing the efficacy of the current Veterinary Surgeons Act and whether changes need to be made to bring the legislative framework for the profession up-to-date, including consideration of the part played by allied professions like veterinary nurses in the veterinary team.
The full report can be downloaded here.
Kate said: "In recent days we have watched the unfolding events in Ukraine in horror, shock and with tremendous sadness.
"We are determined to offer as much help and support as we can to our Ukrainian veterinary colleagues fleeing this crisis and seeking refuge in the UK.
To that end, the College offers a financial support scheme for refugees which is immediately available for Ukrainian veterinary surgeons with refugee status.
The scheme enables refugee vets to take the RCVS Statutory Examination for free, offers financial support to attend exams, free access to the RCVS library and free membership of BSAVA, BVA, BEVA, BCVA and VMG.
In addition, whilst Russian-based business interests comprise less than 0.1% of the College's investment portfolio, it has instructed its fund managers to get rid of all Russian investments at the very earliest opportunity.
Meanwhile, veterinary dentist Bob Partridge has donated a day's takings from his Harrogate-based, Specialist-led small animal dental referral practice, VetDentist, to the British Red Cross Ukraine.
He said: "I got home late and exhausted, turned on the news, and knew that my “tough day” was as nothing compared to the troubles, the fear and the pain experienced by the people of Ukraine."
Other members of Bob's team followed suit, as did the team at Training-Progress, and they hope others will do the same.
Bob said: "Please put your money where your mouth (or keyboard) is!"
https://donate.redcross.org.uk/appeal/ukraine-crisis-appeal
Photo: CC BY-SA 2.0 Aleksej Leonov
The nomination period runs up until 5pm on Tuesday 31 January 2017 and, in order to stand, candidates will need to submit a nomination form, a short biography and personal statement, and supply a high resolution digital photo.
Each candidate also needs two nominators: registered veterinary nurses who are not currently on VN Council.
Liz Cox, Chair of VN Council, said: "With the publication of the VN Futures Report in July there is now huge scope for VN Council members, current and prospective, to take forward some of its recommendations, for example, around clarifying Schedule 3 of the Veterinary Surgeons Act and building a structured and varied career path for veterinary nurses.
"As well as VN Futures there is also a lot of important day-to-day work for VN Council members around veterinary nursing education and professional standards and we would really encourage VNs from all areas of practice to put themselves forward as candidates and to have a say on these crucial issues."
The election period starts around mid-March and will run until 5pm on Friday 28 April 2017. Ballot papers will be sent to veterinary nurses who are eligible to vote in the week commencing Monday 13 March 2017.
Nomination forms, guidance notes and frequently asked questions for prospective VN Council candidates are available at www.rcvs.org.uk/vncouncil17.
Under Schedule 3, vets can delegate medical treatment and minor surgery (not involving entry into a body cavity) to registered veterinary nurses and student veterinary nurses under certain circumstances.
However, following an RCVS survey of the profession to gauge how well both vets and vet nurses understood the provisions of Schedule 3, the College says it was clear that both groups, but especially vets, could benefit from additional guidance and greater clarity.
Following the publication of the survey report, the RCVS Veterinary Nursing Schedule 3 Working Party made a number of recommendations, including the production of a number of case studies (available via www.rcvs.org.uk/schedule3) and a reference poster to help veterinary surgeons in making decisions on delegation in practice.
An A3/A4 poster setting out the principles of delegation has now been prepared and will be printed and posted to all UK veterinary practice premises this autumn.
Ian Holloway, RCVS Director of Communications, who helped develop the poster with the RCVS Standards Committee and the College’s Standards & Advice Team, said: "It was clear from the survey results that we could do more to help vets and vet nurses understand and remember the principles of delegation under Schedule 3, so hopefully our six-point checklist, using the memorable mnemonic 'SUPERB', will do just that.
"If the poster can be placed in a prominent position in the practice setting, we hope it will become a handy, everyday reference tool for all veterinary professionals, and help vets remember the six questions they need to consider before delegating work to their VN colleagues.
SUPERB stands for:
Specific procedure – is the procedure medical treatment or minor surgery not involving entry into a body cavity?
Under care – is the animal under your care?
Person – can you delegate to this person?
Experience – does the RVN/SVN feel capable, and have sufficient competence and expertise?
Risks – have you considered the risks specific to this case?
Be there – are you available to direct or supervise as necessary?
Only if you, as a vet, can answer 'yes' to all six questions, can you delegate the job to an RVN or SVN.
The poster will also available to download from www.rcvs.org.uk/schedule3 where further resources about delegation are available, including links to the relevant chapter of the supporting guidance to the RCVS Code of Professional Conduct and the Schedule 3 case studies.
I think anything which gives veterinary surgeons confidence to delegate more to veterinary nurses is to be warmly welcomed. But what do you think? Do you think this poster would encourage your vets to delegate more, less, or the same? Discuss here.
Dr Kettle faced a charge that he had grabbed the dog, a Shih Tzu named Bella, when she was in a kennel, and/or failed to take sufficient care to ensure that Bella did not fall from her kennel, hit Bella with his hand and/or muzzle, and carried Bella only by her collar and/or scruff.
At the outset, Dr Kettle admitted that he had committed the acts as alleged and that his conduct represented serious professional misconduct.
Having taken evidence from the College and the respondent into account, the Committee considered that Dr Kettle’s actions had not only placed Bella at risk of injury but had also caused her actual injury evidenced by her tongue turning blue for a few seconds, the fact that she soiled herself and her stillness in the treatment room.
However, it also concluded that the incident was a single episode in respect of a single animal that had occurred over a period of 30 seconds, so whilst his actions were serious, they were not aggravated by being sustained or repeated over a period of time.
In terms of mitigating factors, the Committee considered that the circumstances at the time of the incident were relevant.
It found Dr Kettle to be a credible witness and accepted that, during the time that the incident occurred, he had been going through a very difficult time personally with the loss of locum staff, the increased work pressure during the pandemic and unrelated adverse comments on social media.
The Committee considered that whilst these factors did not excuse his behaviour, they had affected how Dr Kettle had reacted towards Bella on the day.
The Committee also noted from clinical records that Dr Kettle had been Bella’s veterinary surgeon for over seven years, on nine occasions prior to the incident and on seven occasions subsequently.
There has been no such evidence of any other incidents happening within this time. Dr Kettle received highly positive testimonials attesting to his usual high standards of practice, both before and since the incident, and the Committee was satisfied that this incident could properly be characterised as isolated and out of character.
Kathryn Peaty, Chair of the Disciplinary Committee and speaking on its behalf, said: “It was clear that Dr Kettle was deeply remorseful and ashamed of his actions, immediately recognising the seriousness of what he had done.
"Indeed, it was apparent to the Committee from Dr Kettle’s evidence that this remorse and regret continue to weigh heavily on him.
“In all the circumstances, although the Committee did not consider that Dr Kettle’s misconduct was at the lower end of the spectrum of seriousness, given the absence of future risk to animals or the public, and the evidence of exemplary insight, the Committee concluded that a reprimand was the appropriate and proportionate sanction in this case.
“The Committee was satisfied that a reprimand would mark Dr Kettle’s misconduct and reassure the public that veterinary surgeons who act as Dr Kettle had done, would face regulatory consequences and sanction.”
Kirsty, who is the Acting Registrar at Scotland's Rural College, will take up the three-year post from the RCVS Annual General Meeting on Friday 3 July 2026.
She has been an elected member of VN Council since 2024 and qualified as a veterinary nurse in 1999.
She has worked in veterinary nursing education for over 20 years in areas including curriculum development and programme validation and accreditation, including chairing veterinary nursing accreditation panels for the RCVS.
She replaces Belinda Andrews-Jones RVN, who has been elected Vice-Chair of VN Council for three years.
Kirsty said: "It's an honour to have been elected by my fellow Council members as Chair of the RCVS Veterinary Nurses Council.
"After more than 25 years in veterinary nursing across clinical practice, education and governance, I'm very proud to take on this role at such an important time for the profession.
"My time on VN Council has been both rewarding and inspiring, and I have valued the opportunity to work alongside dedicated colleagues committed to supporting veterinary nurses and advancing the profession.
"These experiences have reinforced the importance of collaboration, inclusivity and strengthening the veterinary nursing voice.
"As Chair, I look forward to supporting the continued development, recognition and wellbeing of veterinary nurses, while helping to shape the future of the profession through ongoing legislative reform.
"I am committed to driving positive progress and championing the vital contribution veterinary nurses make to animal health and welfare every day."
The RCVS has released the results of a survey which has found that increasing numbers of graduates over the last five years have had little impact on veterinary job prospects.
The survey was carried out for the RCVS by the Institute for Employment Studies, which asked the last five years' UK graduates who have registered with the College how long it took them to find work, how long they stayed in their first jobs, and why they moved on.
The online survey, which achieved a 43% response rate (1,354 responders), found that an average of 94% of graduates seeking a role in clinical practice obtained work within six months of starting to look.
The actual figure ranged from a high of 96% in 2008 to a low of 92% in 2010, and did not change significantly over the five years under consideration, despite UK graduate numbers increasing by around a quarter during the same period (from 650 in 2007, to 819 in 2012). Meanwhile, the College has registered an average of 618 overseas graduates annually during this time.
The survey did show that it was taking graduates slightly longer to secure their posts, with a shift from 85% securing work under three months in 2008, to 71% in 2012.
The results seem to suggest some small differences in the time taken for men and women to find their first jobs, with men finding jobs slightly quicker, although the vast majority of both genders found veterinary work.
Jacqui Molyneux, RCVS President said: "After the announcement from the University of Surrey that it will be opening a new vet school in the near future, there was a great deal of discussion amongst the profession about how easily new graduates could find employment. I undertook to get some real facts and am pleased to find that the picture is not as gloomy as predicted.
However, Jacqui said she was concerned that there has been a slight increase in the proportion of respondents who left their first position after a relatively short period of time. Amongst 2012 graduates, over 40% of those who had left their first position did so within three months of starting work. However it must be stressed that only 18% of those answering the survey who graduated in 2012 had already left their first position. Jacqui said: "Although the turn-over in first jobs seems to be, in part, due to an increase in temporary posts, I am saddened to see that the most commonly-cited reason for graduates leaving their first job was lack of support from their employers or professional colleagues.
"This is an area that we, as a profession, must address. As I have told all the students I have admitted to the College, their first jobs will influence their whole careers, and getting adequate support is probably the single most important factor. Meanwhile, it is heartening to see that nearly all of those moving on have obtained further employment."
Although the survey was sent to all those UK graduates who had registered with the RCVS within the last five years, the contact details for those who had subsequently de-registered may not have been up to date, which may mean that those who had de-registered because they could not find work were not well represented. However, the College says it thinks it is more likely that these individuals would have switched to the 'non-practising' category.
A summary of the headline survey results will be available at www.rcvs.org.uk/publications. The full findings, which also looked at the time taken to complete the Professional Development Phase and the type and location of work sought, will be available in due course.