RCVS Council approves new guidance on ‘under care’ and 24/7 cover
20 January 2023
Following a wide-ranging, lengthy and comprehensive review, the Council of the Royal College of Veterinary Surgeons (RCVS) yesterday approved new guidance on the interpretation and application of an animal being under the care of a veterinary surgeon, and the provision of 24/7 emergency cover, ensuring that it protects animal health and welfare and complies with legislation.
The new guidance will come into effect later this year (see below for reference) having been approved by a majority of RCVS Council members (20 for and three against – see Note to Editors 2) at its meeting on Thursday 19 January 2023, held at the University of Nottingham School of Veterinary Medicine. It follows an extensive review process including consultations with the veterinary professions, animal-owning public and sector stakeholders, legal advice and independent research.
The final 10-week consultation was launched last July and was accompanied by a survey conducted with a sample set of 2,000 UK animal owners via the polling company YouGov as well as outreach with stakeholders in the agricultural/ livestock sectors.
A number of the safeguards included in the guidance to maintain animal health and welfare and maintain public trust were updated following feedback from the consultations
The new guidance contains a number of safeguards to protect animal health and welfare and maintain public trust by ensuring that decision-making remains firmly in the hands of individual veterinary surgeons, as to what they, in their professional judgement, consider appropriate in a specific situation.
A number of these safeguards were updated following feedback from the consultations and include those that:
- require that veterinary surgeons who have taken animals under their care should have the facility available to physically examine the animal and/or visit the premises of animals under their care. Where a veterinary surgeon is not able to provide this themselves they should have a written agreement in place, agreed in advance with another provider to undertake this service;
- require that veterinary surgeons should be prepared to carry out, within an appropriate timeframe, any necessary investigation in the event that the animal does not improve, suffers an adverse reaction or deteriorates;
- provide guidance on what veterinary surgeons should consider in relation to deciding whether they should undertake a physical examination before prescribing POM-Vs;
- require veterinary surgeons to carry out a physical examination where notifiable diseases are suspected, and when prescribing antimicrobials (as defined by the World Health Organisation to include antibiotics, antivirals, antifungals and antiparasitics) and controlled drugs unless there are exceptional circumstances.
The Under Care Review was launched in 2019, although its progress was delayed by the pandemic, and grew out of the joint RCVS and British Veterinary Association (BVA) Vet Futures project, including discussions about the future of telemedicine and remote prescribing within the veterinary sphere, as well as a recognition that the current guidance is not applied in a number of situations. In addition, legal advice provided to the RCVS stated that the College’s then interpretation of the terms ‘clinical assessment’ and ‘under care’ was problematic.
As a result of the evidence and information gathered through the review, including legitimate concerns and comments raised via the consultation process, proposals were put forward that ‘under care’ involved a veterinary surgeon being given and accepting responsibility for an animal and that a ‘clinical assessment’ should be interpreted as including both in-person and remote assessments. The key being that a clinical assessment should provide veterinary surgeons with sufficient information to be able to prescribe prescription-only veterinary medicines (POM-Vs) safely and effectively.
I would like to provide reassurance that many, many hours of thought and consideration have been put into how it will affect veterinary practitioners across all sectors, and animal health and welfare on the ground, while ensuring that the guidance is legally sound and consistent with the current legislation.
Melissa Donald MRCVS, RCVS President
According to the proposals, the issue of whether a physical examination is necessary should be a matter of judgement for the veterinary surgeon in each individual case, bearing in mind a number of factors. In terms of the review of the RCVS guidance on providing out-of-hours care, the guidance from the RCVS for veterinary practices, including advice-only services, remains the same. For limited service providers, the requirements for out-of-hours care also remain the same, albeit with some additional wording defining limited service providers.
The approach, which has now been approved by RCVS Council, is consistent with the legal advice and has significant safeguards to ensure that animal health and welfare remains the utmost priority.
Melissa Donald, RCVS President, who was Chair of the Standards Committee during much of the Under Care Review process, said: “This has been a long journey and I thank all my colleagues on the RCVS Standards Committee, the RCVS Registrar Eleanor Ferguson and her team in the RCVS Standards & Advice Department as well as the research team within the RCVS and the external research agencies for all their hard work on this process.
"I would also like to thank all the individual members of the veterinary team, the veterinary organisations and the members of the public who took the time to get involved in this complex process.
"While we understand that not everybody will be happy with this outcome, I would like to provide reassurance that many, many hours of thought and consideration have been put into how it will affect veterinary practitioners across all sectors, and animal health and welfare on the ground, while ensuring that the guidance is legally sound and consistent with the current legislation."
Due to the fact that the Veterinary Medicines Directorate has stated its imminent intention to carry out a consultation and review of the Veterinary Medicines Regulations (VMRs), RCVS Council also decided that the new guidance will be implemented no earlier than 1 June 2023, and no later than 31 December 2023. These dates will be subject to a final review at Council’s March 2023 meeting.
We are keen that we to help the profession better understand the guidance and its impact ahead of its implementation. Therefore, we will be using this intervening time to prepare additional case studies, FAQs, advice and learning materials to help veterinary professionals understand how the new guidance should be followed within their sectors.
Linda Belton MRCVS
Standards Committee Chair
Linda Belton, Chair of Standards Committee, added: "We are keen that we to help the profession better understand the guidance and its impact ahead of its implementation. Therefore, we will be using this intervening time to prepare additional case studies, FAQs, advice and learning materials to help veterinary professionals understand how the new guidance should be followed within their sectors.
"We also look forward to working with the British Veterinary Association and any other veterinary organisations to ensure their advice and resources are consistent with this new guidance. In the meantime, those with any questions about the new guidance should email [email protected]."
Further information about the College’s additional case studies and resources will be available in due course. Further details about the Under Care Review, including explainers and supporting documents, can be found at www.rcvs.org.uk/undercare, including a full report on the results of the final consultation process.
New guidance
Please note: the following guidance is subject to a small number of minor amends following discussion at Council, and will be augmented with additional case studies and FAQs to aid understanding.
‘Under Care’
Prescribing POM-Vs
This section provides guidance on what it means to have an animal under your care and what is required when carrying out a clinical assessment before prescribing POM-Vs. This section also includes a requirement for veterinary surgeons who have an animal under their care to have the facility to physically examine the animal should it become necessary.
1. According to the Veterinary Medicines Regulations 2013 (VMRs), to prescribe POM-Vs, a veterinary surgeon must carry out a clinical assessment of the animal and the animal must be under their care. The terms ‘clinical assessment’ and ‘under…care’ are not defined by the VMRs, however the RCVS has interpreted them in the following way.
2. An animal is under a veterinary surgeon’s care when the veterinary surgeon is given, and accepts, responsibility for the health of an animal (or a herd, flock or group of animals) whether generally, or by undertaking a specific procedure or test, or by prescribing a course of treatment. Responsibility for an animal may be given by the owner, client or keeper, statute or other authority. A veterinary surgeon who has an animal under their care should have a 24/7 facility to physically examine the animal or visit the premises in the case of production animals, farmed aquatic animals and game. Veterinary surgeons should also be prepared to carry out any necessary investigation in the event that the animal does not improve, suffers an adverse reaction or deteriorates. Veterinary surgeons should provide this service within an appropriate timeframe depending on the circumstances, which could be immediately.
3. Where a veterinary surgeon is not able to provide this service set out in paragraph 2 themselves, another veterinary service provider may do so on their behalf. It is the veterinary surgeon’s responsibility to make these arrangements and it is not sufficient for the client to be registered at another practice. This arrangement should be in line with paragraphs 3.4 -3.6 of the supporting guidance, made in advance before veterinary services are offered and confirmed in writing as part of the conditions of service agreed by the client.
4. Where an animal is under the care of more than one veterinary surgeon, those veterinary surgeons should keep each other informed of any relevant clinical information (see Chapter 5: Communication between professional colleagues for further guidance on mutual clients).
5. A clinical assessment is any assessment which provides the veterinary surgeon with enough information to diagnose and prescribe safely and effectively. A clinical assessment may include a physical examination, however this may not be necessary in every case.
6. Whether a physical examination is necessary for the prescription of POM-Vs is a matter for the veterinary surgeon’s judgement depending on the circumstances of each individual case (please note that the Animals (Scientific Procedures) Act 1986 should be followed where it applies). When deciding whether a physical examination is required, the following factors are relevant, however veterinary surgeons should note this list is not exhaustive:
a. The health condition(s), or potential health condition(s), being treated and any associated risks (see further guidance below at paragraph 5 and 6)
b. The nature of the medication being prescribed, including any possible risks and side effects (see further guidance below at paragraphs 7 and 8)
c.Whether the medication is being prescribed under the cascade (for further guidance on this, see paragraph 4.16 of Chapter 4: Veterinary medicines)
d. When the animal was last physically examined by a veterinary surgeon, or premises physically inspected in the case of production animals, farmed aquatic animals or game
e. Whether there is access to the animal’s previous clinical history or, in the case of production animals, farmed aquatic animals and game, knowledge of the health status at the premises
f. The understanding and knowledge of the owner/keeper
g. Whether the individual animal, herd, flock or group of animals is/are known to the veterinary surgeon and/or whether there is an existing relationship with the client or animal owner/keeper
h. The practicality of a physical examination for individual animals
i. The health status of the herd, flock or group of animals
j. The overall state of the animal’s health
k. The impact of any prescription made without physical exam on the ability to gather subsequent diagnostic information
7. The more complex or unusual the health needs of the animal, or where a differential diagnosis includes serious conditions not yet ruled out, the more likely a physical examination will be necessary.
8. In respect of paragraph 4(a) above, a physical examination is required where a notifiable disease is suspected or part of a differential diagnosis.
9. In respect of paragraph 4(b) above, and given the importance of minimising the development of antimicrobial resistance (please note that in this part of the guidance, ‘antimicrobials’ includes antibiotics, antivirals, antifungals and antiparasitics in line with the definition given by the World Health Organisation):
a. A physical examination is required in all but exceptional circumstances where a veterinary surgeon prescribes antimicrobials for an individual animal or group of animals that are not agricultural animals. Veterinary surgeons should be prepared to justify their decision in cases where antimicrobials are prescribed without a physical examination and record this justification in the clinical notes.
b. When prescribing antimicrobials for production animals, farmed aquatic animals and game, veterinary surgeons should ensure they have an in-depth knowledge of the premises, including its production systems, the environment, disease challenges and the general health status of the herd, flock or group. Veterinary surgeons should have attended and inspected the premises and physically examined at least one representative animal immediately prior to prescribing, or where this is not possible, recently enough to ensure they have adequate information and knowledge to prescribe responsibly. In exceptional cases where this is not possible and antimicrobials are prescribed without conducting a physical examination, veterinary surgeons should be prepared to justify their decision and to record this justification in the clinical notes. For the factors relevant to whether a physical examination is required, please see paragraph 4 above.
Note: For more information about responsible prescribing to minimise antimicrobial resistance, please see Chapter 4: Medicines, paragraphs 4.23 and 4.24.
10. In respect of 4(b) above, when prescribing controlled drugs to an animal in the first instance, veterinary surgeons should carry out a physical examination in all but exceptional circumstances and be prepared to justify their decision where no physical examination has taken place. This justification should be recorded in the clinical notes. It is acceptable to issue a repeat prescription for controlled drugs without a physical examination, however veterinary surgeons should carry out a further clinical assessment to ensure they have enough information to do so safely and effectively.
11. Veterinary surgeons must maintain clinical records of animals, herds, flocks or other groups of animals under their care.Limited Service Providers
1. A limited service provider is a practice that offers no more than one service to its clients and includes, but is not limited to, vaccination clinics, equine reproductive clinics and neutering clinics. For these purposes, a 'practice' is a Registered Veterinary Practice Premises (RVPP) as entered into the register held by the RCVS.
2. Limited service providers should provide 24-hour emergency cover that is proportionate to the service they offer. This means that veterinary surgeons working for limited service providers should ensure that the 24-hour emergency cover provision covers any adverse reaction or complication that could be related to procedures or examinations carried out, or medicines prescribed or used.
Notes for Editors
1. The RCVS is the regulatory body for veterinary surgeons and veterinary nurses in the UK and sets, upholds and advances veterinary standards, so as to enhance society through improved animal health and welfare.
2. During the afternoon’s closed session of the Council meeting, RCVS Council member Professor James Wood explained that he had only voted ‘no’ to approving the new guidance, as he understood the guidance was to be published imminently. Had he realised at the time there was to be a subsequent discussion about when the guidance should be implemented, he stated he would have voted ‘yes’ to approve the new guidance in principle. Whilst Professor Wood understood he would not be able to change his vote retrospectively, he wished to place on public record his support for the new guidance.