The London Vet Show will next take place on 11th and 12th November 2021 at the ExCeL Center, London.
CloserStill says the decision to cancel was made following several discussions with industry stakeholders, including partners, and considering the significant impact of both international and domestic travel.
Rob Chapman, MD of CloserStill’s veterinary portfolio, said: "COVID-19 has brought enormous pressures and uncertainty to the veterinary sector - both personally and professionally.
"Although the UK Government gave the green light for exhibitions and meetings to start again in October, after examining at the overall market and consultation with our partners, we feel the decision to postpone is in the best interest of the veterinary community.
"Although this news may be disappointing to those looking forward to the London Vet Show, unfortunately the coronavirus situation is continually developing. We want to be as clear and upfront as possible with our community and customers, and after careful consideration, our decision to reschedule was out of caution. As event organisers, the health and safety of our exhibitors, delegates, speakers, staff and supporters, is our number one priority."
"Obviously the postponement decision hasn’t been easy but we firmly believe it’s the right thing to do. We are so fortunate to have support of great partners like the Royal Veterinary College and the British Veterinary Association, along with the exhibitors, speakers and delegates we’ve spoken to so far; everyone has been really understanding. We can’t wait to see you all again virtually soon, and in person in 2021."
"The team and I are eager to continue to provide world-class education to veterinary professionals, to connect and encourage networking to foster the advancement of the veterinary sector. We are developing some great opportunities for the veterinary community come November. We will be announcing more details on this very soon."
James Beaumont, Product Manager at Animalcare, said: “Microchipping is an essential but simple way to safeguard the welfare of the UK’s horses. Animalcare was the first company to offer a microchipping service with its identichip microchips, so we know from first-hand experience that microchipping is the most important step owners can take to ensure that lost, abandoned or stolen animals are quickly identified.
“Ensuring the welfare of their patients is a guiding principle for equine vets and we know that they are working very hard to remind owners of the need to ensure that their animals are microchipped and to then keep their contact details up to date. We hope that they will find our social media toolkit useful and that, between us, we can ensure that as many horses as possible are microchipped in time for the new law coming into force.”
To request your social media toolkit, contact your Animalcare Territory Manager or ring 01904 487687.
The company says the system uses a combination of image recognition technology, algorithms and cloud-based artificial intelligence to deliver accurate testing results at the time of visit, within 9 minutes in fact, giving veterinary surgeons the ability to diagnose and treat patients quickly, without the need for a second appointment.
Vetscan Imagyst will detect the eggs, cysts, and oocysts of whipworm, hookworm, roundworm, Giardia, and coccidia
Richard Goldstein, DVM, DACVIM, DECVIM-CA, VP Global Diagnostics Medical Affairs at Zoetis, said: "Parasites are a threat throughout the year, making routine monitoring critical to pet health.
“With Vetscan Imagyst, the ability to have accurate, fast results at the point-of-care empowers veterinarians to diagnose and treat in the same visit, increasing compliance and eliminating follow-up appointments and call backs, thus enhancing the overall pet owner experience.”
Vetscan Imagyst will launch in the UK next week. For more information, contact your Zoetis representative or visit at www.vetscanimagyst.com.
Mary (or, to give her her full title, Dr Mary Fraser BVMS PhD CertVD PGCHE FHEA MAcadMEd CBiol FRSB FRSPH FRCVS) focussed on decision-making in practice while studying for her MRes in Clinical Veterinary Research, looking at how vets and owners influence the decision making process. This led her to consider how decision making is taught to students.
As part of the initiative, Mary has launched a new website: www.clinicaldecisions.org, which, together with a supporting blog, is designed to help nurses, students and recent graduates examine their decision making in practice, consider how owners influence it, and take forward shared decision making for the benefit of all.
Mary said: "As a student decision making can seem difficult. Working with owners, all of whom have different expectations, can add to those challenges.
"I hope that by bringing that discussion to the fore we can support each other and allow future vets and veterinary nurses to identify their own strengths in supporting owners to make the best decisions for their animals."
Find out more and contribute to the discussion at www.clinicaldecisions.org
Willows' Head of Imaging Andrew Parry, an RCVS and European Specialist in Diagnostic Imaging (pictured on the left with Clinical Director, Toby Gemmill), said: "There are very few veterinary hospitals anywhere in the country which would have the case-load or the complexity of cases to justify such a sizeable investment. Additionally, this magnet will bring multiple opportunities for clinical research which could ultimately lead to improvements in animal health."
Andrew added: “To my knowledge, we are the only centre in the UK that has fully replaced a high-field magnet MRI with a complete new solution.
"This is very unusual as scanners tend to be upgraded from a high field to higher field, rather than replaced altogether.
"However, our aim wasn’t to purely upgrade the equipment, it was to have access to the best diagnostic imaging equipment available, in order to ensure high quality images are obtained and interpreted, providing the most accurate and rapid diagnosis for our patients. This can make a significant difference to the level of care we are able to provide for pets."
For more information, visit: willows.uk.net
In writing the guide, Liz has drawn upon her own experience of the disciplinary process to offer practical advice to others who find themselves in the same situation.
Liz found herself on the receiving end of a complaint by a pet owner after an elderly dog she had operated on died that night at her practice. It took two years for the complaint to progress to a DC hearing. They were two years which she described as absolute hell. Not just because of the threat of losing her livelihood, but also because of the vilification on social media.
Her booklet explains the whole process, from the first notice from the College to moving on after the hearing, with practical advice as to how you can make the experience, well, if not a positive one, at least not quite as hellish as it might otherwise be.
You can download the booklet from Liz’s website, here: https://howtosurviveanrcvshearing.wordpress.com/
The company has completed a health hazard assessment which concluded that any risk to animal and human health is likely to be low and no greater than expected for this product under normal conditions, as described on the product labelling.
The recall is for the following batches only:
Batch Numbers:
0265-900302-900246-900112-900295-909053-919103-91
Norbrook Laboratories Ltd is contacting veterinary surgeons to examine inventory immediately and quarantine products subject to this recall.
For further information, contact Gary Mckee on +44 2830 264435 or email gary.mckee@norbrook.co.uk
Emma will take over from Kate O’Sullivan MRCVS as the chair of Cymru/Wales region committee in April 2021.
Emma is the first veterinary nurse to be appointed to these positions since the BSAVA gave nurses full voting rights last November, a change which means they can hold any position within the Association, including the presidency!
Emma, who works at Hafren Veterinary Group, an independent mixed practice in Powys, has been a member of the Committee since 2013 and worked alongside Kate and other committee members to launch and host the new event Vets Cymru in 2019. She has also served on the BSAVA Membership Development Committee and has recently become the new Editor of the Pocketbook for Vet Nurses.
As Council Representative Emma will interact with Trustees and members of the Management Team at Woodrow House and will seek members’ views within Cymru/Wales region and make sure they are reflected in discussions at Council meetings.
She said: “Being appointed the first VN Council Representative and Regional Chair is a massive achievement for myself and my nursing colleagues. It hasn’t been possible for a VN to fill a Regional Officer role until now. I know how long and hard colleagues have worked in order to make this happen and, for that, I am grateful. As the Committee Chair, I would really like to fly the flag for nurses I hope to inspire and empower nurses to join the Association and illustrate what opportunities are available.”
BSAVA President, Professor Ian Ramsey said: “I am so pleased that BSAVA Cymru region has elected a nurse as their Regional Chair and Council Representative.
"Nurses have already served the Association with distinction in many of our Committees for several years and this is another step towards recognising the importance of nurses within the veterinary team and therefore within the Association. I look forward to seeing more nurses coming forward to help shape the Association in the future."
Ian added: "The RCVS Council has, for a few years now, allowed nurses to be full members and so we are not the first veterinary organisation to break this particular glass ceiling but we are proud to have added to the sound of smashing glass!"
To find out how you can become a volunteer with your regional group visit https://regions.bsava.com/t/volunteering-opportunities-with-bsava/95
The charity says that many of the calls and emails were linked to the coronavirus pandemic.
Vetlife Helpline Manager Dr. Rosie Allister said: "It has been a very difficult time for many people in the veterinary community, and we are glad so many people have been in touch.
"As well as calls relating to the effects of the pandemic, other stresses haven’t gone away and we are still offering support for people experiencing stress, concerns about mental health, work demands, support at work, and many other concerns.
"It is a privilege to support the veterinary community and I would like to reassure anyone thinking about contacting Vetlife Helpline that we are here to listen confidentially. Anyone who thinks they might need to talk can contact by phone or email.”
The Vetlife Health Support service also saw a record number of referrals.
Katie Moore, Chair of Helpline and Health Support said: "Given the extraordinary challenges faced by our profession both in 2020 and now in 2021, it is not surprising that not only Vetlife Helpline but also Vetlife Health Support have experienced their busiest 12 month period, with a large increase in referrals to our Health Support service over recent months. I would strongly encourage anyone who is concerned about any aspect of their mental health to get in contact as soon as possible.”
The charity is also appealing for help with donations and fundraising to meet the extra demand. Donations can be made at https://www.vetlife.org.uk/donate/, and anyone who is planning a fundraiser is urged to contact the charity. If you are interested in volunteering, there are a number of ways to get involved. For more information, visit: https://www.vetlife.org.uk/volunteer/.
Vetlife Helpline is available 24 hours a day, 365 days a year on: 0303 040 2551 or via anonymous email at: https://helpline.vetlife.org.uk/
The materials include a 15-minute video in which Sarah (pictured right) gives her advice on the medical management of hyperthyroid cases. She also introduces Thiamacare, Animalcare's high strength (10mg/ml) thiamazole oral solution, launched by the company last year.
Sarah has also helped to produce an in-clinic infographic which offers practical tips on handling hyperthyroid cats in order to minimise stress, as low-stress handling is known to help benefit treatment outcomes. The infographic also contains tips for owners on transporting cats, gives advice to practices on how to make waiting rooms and consult rooms cat-friendly and suggests considerations for blood-sampling and therapeutic assistance.
The materials are all available free of charge from www.the-pac.co.uk
James Beaumont, Brand Manager, said: ‘’Hyperthyroid cats can be challenging to treat and to handle. We hope the educational resources we have developed with Dr Caney will support practice teams in strengthening the management of these cases, ensuring higher welfare for affected cats and supporting the human-companion animal bond.”
For more information, email: animalcare@animalcare.co.uk or telephone 01904 487687.
The disease, which originally appeared in the late 1980s, was first detected in the UK in 2012. It affects the kidneys and has a 90% mortality rate.
The team at Anderson Moores, which has been leading research into this disease, wants to alert colleagues to these new cases, which have been confirmed since 1st January.
By comparison 18 cases were reported in the whole of 2018, 19 in 2019, and 47 in 2020.
The new cases have been identified in Herefordshire, Greater London and Exeter.
David Walker, American, RCVS and EBVS European specialist in small animal internal medicine, leads the team at Anderson Moores Vet Specialists and is the UK’s foremost authority on the disease. He said: “We’re very sad to confirm three new cases of CRGV already in 2021. Unfortunately, we find ourselves at the time of year when cases are most commonly identified.
"As well as these confirmed cases, we are awaiting results on a number of other dogs that have sadly been euthanised with suspected CRGV. It is understandably a worrying time of year for dog owners with regards to CRGV; however, the disease remains rare.
"We’re advising dog owners across the country to remain calm but vigilant and seek advice from their local vets if their dog develops unexplained skin lesions.”
Previous cases have been identified in Gloucestershire, Surrey, Derbyshire, Yorkshire, Lancashire, Cornwall, Devon and Staffordshire.
Mr Walker added: “If a dog becomes affected by CRGV, the best chance of recovery probably lies with early and intensive veterinary care which may be best provided at a specialist facility such as Anderson Moores.
“Treatment primarily revolves around intensive management of the acute kidney injury and is sadly only successful in around 10% of cases.
“However, the team here at Anderson Moores successfully treated a suspected case of CRGV in a Labrador Retriever. Molly was referred to our internal medicine team just before Christmas due to limb swelling and a deep, painful ulcerative lesion on one of her legs.
“Following four days’ intensive treatment, her condition started to improve and we began to cautiously hope she would survive the disease.
“Molly continued to slowly improve and, after two nerve-wracking weeks, she was discharged to continue her recovery at home."
To find out more about CRGV, visit www.andersonmoores.com and the Alabama Rot Research Fund at www.arrf.co.uk.
The NHS doctor, television presenter, author and columnist will be sharing his insights on the mental health challenges of working within a caring profession under the constraints of the pandemic.
Dr Ranj is the second keynote speaker to be confirmed, the first being Jenny Campbell and the third to be revealed next month. They will be joining a line-up of more than 100 UK and International contributors during the three days of the event.
Dr Ranj is familiar with the intense pressure that many veterinary professionals are facing when juggling working in a sometimes emotionally stressful environment with that of home life. When the pandemic started Dr Ranj took a step back from media work to focus on supporting the NHS in his role as a paediatric emergency medicine specialist. He said: "Maintaining wellbeing is all about doing the basics right.
“We are in a pandemic and people are under intense pressure - from work, from home life, from a health perspective and so much more. So, despite everything going on around you, make sure you have a routine every day.
"Get out and about safely. Build some physical activity into your schedule. Nourish your body with everything it needs, and make sure you allow yourself some treats too! Take a moment for yourself every day to do something that makes you feel good.
"Take time to connect with others safely and check in on the vulnerable too. Celebrate the little victories and achievements that you have. And at the end of the day, make sure you look after your sleep because that's when your brain and body recover from the stresses of everyday. Everything else we do is a bonus on top of those basics. And if you are struggling, make sure you reach out for help and speak to someone."
BSAVA President Ian Ramsey said: "We are delighted to welcome Dr Ranj as one of our three keynote speakers this year. One of the many advantages of Congress evolving into a virtual event for 2021 is that we can be more flexible and creative with our sessions and how we fulfil the needs and expectations of every member of the practice, from clinical, interactive, wellbeing and social perspectives. Our three keynote presentations are eagerly anticipated.”
Prices for BSAVA Virtual Congress start at £99 +VAT for members. To register visit https://www.bsavaevents.com/bsavacongress2021/en/page/home
The inquiry in regard to Karen Tracey Hancock took place in her absence in January, after she indicated that she was content not to appear or to be represented.
The charges against Mrs Hancock related to an injury she falsely claimed she sustained to her knee while moving a euthanased dog in August 2015 that was then exacerbated while moving another dog a couple of weeks later.
The charges also stated that she made entries in the practice’s accident book also stating that she had injured her knee at work and then aggravated it later.
The charges also stated that, in County Court civil proceedings against the practice in relation to the alleged injuries, she falsely:
The Committee noted that the County Court claim made by Mrs Hancock was listed for a trial and concluded with a consent order dated 21 June 2019 which stated that the claim was dismissed.
It also considered evidence from eyewitnesses regarding the two alleged events that led to and exacerbated her knee injury in August 2015. In doing so the Committee found that, though Mrs Hancock did have an injury to her right knee, this was due to a horse-riding incident a number of years earlier and that her account of the incidents on 13 and 29 August, and therefore her claims to have been caused injury by them, were false and that her conduct had been dishonest.
The Committee therefore found all charges against Mrs Hancock proven.
The Committee then considered whether the proven charges amounted to serious professional misconduct. In doing so it considered submissions made by Counsel for the RCVS that there were a number of aggravating factors in the case of Mrs Hancock’s conduct including that the misconduct was sustained over a long period of time, was premeditated and involved lying for financial gain.
In commenting on whether the conduct was serious professional misconduct Judith Way, chairing the Committee and speaking on its behalf, said: “The Committee found all of the aggravating factors set out… in this case applied to its decision on whether or not the conduct amounted to disgraceful conduct in a professional respect.
"Such conduct would bring the profession of veterinary nurses into disrepute and would undermine public confidence in the profession because the dishonesty was directly concerned with the respondent’s work as a veterinary nurse in the veterinary practice.
"The Committee concluded that the dishonest behaviour was serious misconduct, particularly so because it took place at the respondent’s workplace. It considered that honesty and trust between veterinary nurses and their employers is essential to the profession and that such conduct as set out in the charges would be considered deplorable by other members of the profession."
The Committee was therefore satisfied that all four charges individually and cumulatively amounted to serious professional misconduct.
Committee members then considered the appropriate sanction for Mrs Hancock, taking into account the aggravating factors, including a lack of insight in that, in correspondence before the hearing, she continued to deny the charges. In mitigation it noted that there had been a significant lapse of time and that she had a long and hitherto unblemished career.
On balance it decided that removal from the Register was the appropriate and proportionate sanction and requested Mrs Hancock be removed from the Register, particularly as dishonesty is considered ‘in the top spectrum of gravity’ for misconduct.
Judith Way added: “The Committee acknowledged that the respondent was physically unwell with her knee between 2015 and 2019. However there was no evidence that her health had caused her to commit the misconduct. It noted the representations that the respondent made regarding the need to support herself financially but the Committee determined that the public interest outweighed the respondent’s own interests in this case because the proven dishonesty in the circumstances in which it took place was fundamentally incompatible with continued professional registration.
“In the Committee’s judgment without any evidence of remorse or insight by the respondent a suspension order could not meet the public interest in this case. It therefore concluded that removal of the Respondent’s name from the register was the proportionate and appropriate sanction in this case.”
The change to the Practice Standards rules means that RVNs who have at least five years’ experience within the profession are eligible to apply to become PSS Assessors.
PSS Assessors are employees of the RCVS who are responsible for visiting practices that want to join the scheme, are undergoing their re-accreditation assessment or have applied for one or more of the PSS Awards, to ensure they meet the criteria.
The decision to allow RVNs to become PSS Assessors had already been approved by both the Practice Standards Group (the steering committee for the Scheme comprising representatives from all of the major veterinary and veterinary nursing organisations in the UK) and the RCVS Standards Committee.
Matthew Rendle is the Chair of VN Council and also sits as a member of RCVS Council. He said: “I am delighted to see that there is now a pathway to recruit veterinary nurses as PSS Assessors and hope that many of my VN colleagues will take up this opportunity to apply to join the excellent team responsible for ensuring that the Scheme’s stringent standards are met.
"We know that, on a practice-by-practice basis, veterinary nurses often play a big role in helping to coordinate and ensure that the requirements of the Practice Standards Scheme are met, for example, by preparing their team for the assessment, liaising with the RCVS and the Assessor and making sure all standards are complied with in advance. It is great to see that the crucial role they often play in meeting standards is reflected in opening up the ability to become PSS Assessors."
Mandisa Greene, RCVS President and Chair of the Practice Standards Group, added: “This is such an important development for the veterinary nursing profession whose role in the Practice Standards Scheme has long been recognised as invaluable. This decision also opens up new career advancement opportunities for the profession as well, which I’m sure is very welcome."
When the next recruitment round for PSS Assessors takes place, RVNs will be invited to apply to join the roster of Assessors.
In addition to approving the role of RVNs as PSS Assessors, Council also approved a new Equine Emergency Services Clinic accreditation to help incorporate the emerging business model of veterinary practices that provide ambulatory emergency services for equids.
The new accreditation would require these practices to meet the applicable PSS Core Standards, plus the requirements contained in an additional Equine Emergency Services module. The full details of the requirements will be published in due course.
For more information about the Practice Standards Scheme visit: www.rcvs.org.uk/pss
According to the survey, 64% of veterinary surgeons now see Brexit as more of a threat than an opportunity for the UK veterinary profession, compared to just half in autumn 2016. Conversely, the number that see Brexit as being more of an opportunity has dropped from 18% to 14% over the same period.
Vets working in academia and industry were the most gloomy: 69% of vets in academia and 58% of vets in industry see Brexit as more of a threat to their own area of work than an opportunity.
The biggest impact appears to have been on veterinary recruitment, with 53% saying Brexit has made it harder to recruit veterinary surgeons, compared to only 18% in 2016. By comparison, only 11% said it has become harder to recruit veterinary nurses.
51% also now consider Brexit as a threat to animal welfare, compared to 43% in 2016.
BVA President Simon Doherty (pictured right, looking decidedly chipper despite it all) said: "As the UK Government ramps up its planning for a no-deal scenario, it’s clear that the veterinary profession is becoming increasingly concerned about the potential impact of Brexit.
"Top of vets’ list of concerns is significant veterinary workforce shortages across critical areas of animal welfare and public health. Veterinary concerns around animal welfare have also increased as the Government continues to stall on introducing new legislation to enshrine animal sentience in UK law before March.
"From pet passports and food safety, to disease surveillance and trade certification, there is no area of veterinary work that is not touched by Brexit. So, we can fully understand why our members are worried about the future. BVA will continue to raise these important veterinary issues with policymakers to ensure the profession is considered as Brexit discussions continue."
The BVA briefings on “Brexit and the veterinary profession” and “No deal Brexit and the veterinary profession” set out all of the issues of interest in more detail.
Amanda Boag, RCVS President, said: "We understand that this is a concerning situation for many in the profession who are worried about the impact of the shortage of isoflurane on both elective and emergency operations.
"We are also concerned to hear that some vets are worried that they may be disciplined by the RCVS for clinical decisions and outcomes that may arise from the shortage, and so we are keen to stress that we understand that members of the profession can only do their best under the circumstances presented to them and that, provided they can clinically justify the decisions they have made, keep detailed notes, gain informed consent and follow the prescribing rules, then there is very unlikely to be an issue of professional misconduct."
If you have questions about the shortage in relation to the Code of Professional Conduct and its supporting guidance, you can contact the RCVS Standards and Advice Team on 020 7202 0789 or advice@rcvs.org.uk.
For further information about the shortage and alternative sources and products, the RCVS recommends visiting the Veterinary Medicines Directorate website: www.gov.uk/government/organisations/veterinary-medicines-directorate.
The two-day event, now in its fifth year, aims to combine world-class CPD for the whole practice team with an outdoor ‘festival’ atmosphere.
The organisers say that the wellbeing of veterinary professionals has always been a strong focus of VET Festival, but the inclusion of Lara Heimann in the Wellness and Practice Development lecture, takes it to a new level. Laura has developed her own vinyasa yoga style and regularly leads international retreats and workshops.
Speakers in the clinical programme will include:
Dr Antonio Pozzi, Head of the Clinic for Small Animal Surgery at the University of Zurich, Switzerland
Dr Susan Little, co-owner of two feline specialty practices in Ottawa, Canada, and past president of the American Association of Feline Practitioners
Dr Ronaldo da Costa, Professor in Neurology and Neurosurgery at Ohio State University, USA.
Veterinary cardiologist Professor John E Rush. A Diplomate of both the American Colleges of Veterinary Internal Medicine and Emergency and Critical Care, Dr Rush has been a professor for 25 years at the Cummings Veterinary Medicine Centre at Tufts University in Massachusetts
Behaviourist Dr Sarah Heath. A founding Diplomate of the European College of Animal Welfare and Behavioural Medicine
Soft-tissue surgeon Professor Christopher Adin. Professor Adin is Chair of the University of Florida’s Department of Small Animal Clinical Sciences and Associate Professor of Soft Tissue.
Veterinary nurses are welcome to attend any of the lectures, in addition to those in the dedicated nursing stream. An exhibition of the latest products and services for all veterinary professionals takes place in a dedicated arena.
Nicole Cooper, event director, said: "VET Festival is unique in bringing together cutting-edge, inspirational learning, fun and the great outdoors. CPD from our world-leading speakers is delivered in a high quality and contemporary setting but, once work is done, we encourage delegates to relax and enjoy free admission for them, their friends and family to the VETFest Live Party Night."
She added: "With the wellness and wellbeing of members of our profession increasingly in the spotlight, we’re delighted to welcome Lara Heimann for 2019 and hope that she will help our delegates to develop practical solutions to living healthier and more balanced lives."
Supported by MWI Animal Health, VET Festival also offers a 'Family Hub', a place where children can play whilst their parents listen to lectures.
Alan White Group Commercial Director at MWI Animal Health, said: "Balancing work and family life can often be a juggling act, particularly in the veterinary profession where time is in short supply. This can sometimes compromise the work-life balance of vets, nurses and other team members. At VET Festival, the 'Family Hub' means that there is no compromise and that both our attendees and their families can get the best out of their time with us."
You can buy tickets here: https://www.vetfestival.co.uk/delegate-info/ticket-information
Mr Kashiv first appeared before the Committee in December 2016 in relation to four charges against him regarding his inadequate treatment of a Scottish Terrier called Tanzy which was ultimately euthanased due to renal failure.
The first charge related to Mr Kashiv’s original consultation with the owner in March 2015 and his failure to investigate for renal disease; his failure to discuss with the owner investigations to assess metastatic spread; failure to discuss with the owner alternative options to surgery such as palliative care or euthanasia and failure to explain to the owner key factors with regards to the surgery he had suggested to her, including its nature and extent, the risks involved, the fact another vet would be performing the surgery, and what to expect post-operatively.
The second charge related to the fact that, having admitted the dog as an in-patient at the practice, he failed to conduct further investigations regarding her poor condition; provide any or any adequate pain relief, or fail to record the same; failed to discuss with the owner the dog’s poor prognosis and failed to discuss with the owner the option of euthanasia.
The third charge related to the fact that Mr Kashiv discharged the animal back into her owner’s care when she was not in a fit state for discharge. The fourth and final charge related to the fact that Mr Kashiv failed to keep sufficient clear, detailed and accurate clinical records for his treatment of the dog.
At his original hearing in December 2016, the Committee found the four charges proven and also found that charges 1 to 3 amounted to serious professional misconduct. However, the Committee decided to postpone the judgement for two years, whilst recommending that Mr Kashiv agree to undertake a structured programme to improve his clinical practice, including putting together a personal development plan, having a mentor, accepting regular practice visits and undertaking additional continuing professional development (CPD).
The resumed hearing took place on Tuesday 18 December 2018, during which the Committee heard evidence from Dr Writer-Davies MRCVS (the veterinary surgeon appointed to review Mr Kashiv’s practice and report back to the Disciplinary Committee over the two year period), Mrs Somers MRCVS, (his appointed mentor), and Mr Kashiv himself.
Dr Writer-Davies told the Committee that she had no concerns about Mr Kashiv’s abilities regarding patient safety and that, in her view, he now meets the standards of a reasonably competent veterinary surgeon. She cited the fact he had gained in confidence when communicating with clients, had undertaken a considerable amount of CPD focused on the areas of concern identified in the case, that she had observed more detailed record keeping from him and that a veterinary nurse had been appointed to assist in running Mr Kashiv’s practice.
The evidence from Mrs Somers also found that Mr Kashiv’s knowledge was in line with that expected of a reasonably competent veterinary surgeon and that she had observed a good quality of care for pets and their owners from him.
Mr Kashiv also gave evidence, which the Committee said demonstrated considerable insight into his previous conduct and a good attitude towards self-reflective practice. The Committee also felt that the testimonials provided by Mr Kashiv showed him to be a kind and caring veterinary surgeon.
Stuart Drummond, chairing the Committee and speaking on its behalf, said: "The Committee considers that, having successfully completed the undertakings, Mr Kashiv is now a safe practitioner. The last two years has allowed Mr Kashiv to develop his skills particularly in the area of communication.
"However, the Committee has not lost sight of the fact that this was a serious case and that there was substantial harm caused to Tanzy.
"The Committee considers that in the intervening two years Mr Kashiv has gained considerable insight, developed better communication skills and remains open to improving his practice. It therefore imposes a reprimand on Mr Kashiv. The Committee considers that a reprimand is the appropriate and proportionate sanction to uphold proper professional standards and to maintain public confidence in the veterinary profession."
Ceva says the adverts, which will air on Channel 4 and Channel 4 partner channels until 20th January, will reach 15 million people. That might prove a conservative estimate though, because the Adaptil advert on YouTube has already had over 800,000 views, whilst the Feliway advertisement has had very nearly as many.
In addition, Adaptil has partnered with The Times to support its 'Walking the Dog' podcast series hosted by radio presenter and journalist Emily Dean.
During the podcasts, Emily talks with celebrities like Noel Fitzpatrick, Jimmy Carr, Rob Bryden and Jonathan Ross as they walk their dogs. An Adaptil advert airs at the start, middle and end of each podcast.
You can hear the podcasts on itunes here: https://itunes.apple.com/gb/podcast/walking-the-dog-with-emily-dean/id1220510307
Abigail King, behaviour product manager at Ceva Animal Health said: "Our new TV advertising campaigns and podcast partnership will boost awareness of both Adaptil and Feliway throughout the festive period and into January, when changes to routine, visitors in the household and loud noises from Christmas crackers and fireworks can challenge even the most laid-back pet."
For more information, visit: www.adaptil.com or www.feliway.com.
The winners and runners up will be honoured at a ceremony taking place on the eve of BSAVA Congress on 3rd April 2019.
Matt Baker, presenter of The One Show and Countryfile, will be hosting the Ceva Animal Welfare Awards alongside the head judge, Chris Laurence MBE FRCVS, who puts his name to the Vet of the Year Award.
The award categories include:
Chris Laurence Vet of the Year – sponsored by Vet Record
Vet Nurse of the Year – sponsored by Agria Pet Insurance
Charity Team of the Year – sponsored by PDSA
Charitable Contribution of the Year – sponsored by Blue Cross
International Cat Care Welfare of the Year – sponsored by International Cat Care
Farmer of the Year – sponsored by R.A.B.I.
Farm Educator of the Year – sponsored by NADIS
Outstanding Contribution to Animal Welfare – sponsored by Your Dog and Your Cat magazines
To nominate someone for an award, visit www.cevawelfareawards.com. They can come from all walks of life and will be assessed on the evidence provided in the original nomination.
Entries must be in by Friday 25 January 2019.
Dermanolon contains triamcinolone acetonide and salicylic acid. Presented in a 75ml spray bottle, Dechra says it is designed to target lesions in hard to access spots and is a useful alternative for animals when shampooing is not possible.
Triamcinolone acetonide, a moderately potent steroid with an anti-inflammatory and vasoconstrictive action, suppresses the inflammatory response and the symptoms of various disorders often associated with itching.
Salicylic acid gives a keratolytic effect and also removes excess skin cells when applied cutaneously and provides a drying effect, which prevents maceration.
Dechra Brand Manager Carol Morgan said: "Seborrhoeic dermatitis is associated with a higher skin pH compared to that of healthy dogs so Dermanolon’s low pH of approximately 2.7 reduces the pH of the skin following application giving an antibacterial and antimycotic effect.
"It also contains ethanol that prevents the build-up of a greasy film on the skin and has bactericidal properties."
Carol added: "Seborrhoeic dermatitis can be a debilitating condition for animals and a challenge to treat effectively. Adding Dermanolon to our portfolio offers veterinary professionals another valuable tool for the care and treatment of animals with dermatological diseases."
For more information on Dechra’s dermatology range, visit: www.dechra.co.uk.
The Cat Friendly Veterinary Professional course is aimed at veterinary surgeons and nurses and covers all aspects of being cat friendly over six modules, including understanding where cats come from, their behaviours, stress free handling, how to be more cat friendly in practice and client communication.
The four-module Cat Friendly Veterinary Receptionist course is aimed at receptionists and includes everything a receptionist needs to know about cats and how to be cat friendly, including their role in making the practice cat friendly.
Both are 3 month online courses, with students working through the modules at their own pace. There is a short assessment at the end of each module and on successful completion of the course students will receive a certificate and badge.
Sarah Endersby, ISFM’s Veterinary Development Manager, said: "We are very excited to offer cat friendly training for individuals. The courses are suitable for all members of the practice team, and you do not have to work in an accredited Cat Friendly Clinic to study with us, meaning that there is something for everyone."
For more information and to sign up, visit https://icatcare.org/cat-friendly-courses.
The charity-run Vetlife helpline, which offers 24/7 confidential support, says it had 2775 contacts from members of the profession last year, up 160% on the previous year.
Vetlife Operations Manager Joanne Driver said: "We’re aware that for many the impact of seasonal work pressures for vet practices and the stresses of the already hectic Christmas period do not simply disappear when January arrives. When paired with mental health issues or personal worries, it can continue to feel overwhelming.
Vetlife helpline is a safe place to talk for those who are struggling, and our volunteers can signpost callers to resources and our health and financial services.
"It can be hard to spot colleagues who are struggling or to find ways to offer the help they need. By supporting Vetlife you can help us ensure there is a friendly anonymous voice at the end of the phone or via email for everyone in the veterinary community who needs it. Vetlife is largely run by volunteers and we rely on your support and donations to keep the services running.
"Please make a meaningful resolution this year and support Vetlife through a donation, by becoming a member or by joining as a volunteer."
If you would like to support Vetlife, there are a number of ways to help:
DonateAs a registered independent charity, Vetlife relies on the generosity of the people in the veterinary community and veterinary organisations to be able to continue its work. The simplest way to donate is online at: www.vetlife.org.uk/support-us/donate/
VolunteerVetlife is almost entirely managed and run by its volunteers. To learn more about volunteering for Vetlife Helpline or as an Area Representative, visit www.vetlife.org.uk/support-us/volunteer/
Vetlife Helpline is available on: 0303 040 2551 or email via www.vetlife.org.uk
The company says its Skinsights Learning Academies help support individuals and practices improve the healthcare outcomes for the 25% of dogs medicalised by skin problems in the UK.
A number of recognised industry professionals will be giving interactive, bite-sized talks at the events, including: Filippo De Bellis, Ian Wright, Jill Maddison, Sarah Warren, Rob Pope, Evelyn Maniski and Emily Robson as well as Zoetis veterinary and business consultants.
Zoetis says all the presentations will be highly practical, presented through case reviews, research, workshops and discussions. They will offer the latest information on game-changing therapeutics, best practice work-ups, effective protocols and insightful case-studies.
The sessions are limited to groups of 30 and Zoetis says places are expected to fill quickly.
To reserve your free place, visit: http://www.zoetis.co.uk/LVS2018
If you are unable to secure a seat in the theatre, headsets will be available on the day so you can listen to the lectures whilst on the stand.
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!