'Under care' - new guidance

The Veterinary Medicines Regulations 2013 state that before prescribing POM-Vs, a veterinary surgeon must carry out a clinical assessment and the animal in question must be under their care.

The VMRs do not define ‘clinical assessment’ and ‘under care’, so it falls to the RCVS to do so via this guidance.

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.

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 must be able, on a 24/7 basis, to physically examine the animal, or visit the premises in the case of production animals, equines, farmed aquatic animals and game.

Veterinary surgeons should also be prepared to carry out any necessary investigation in the event that animals taken under their care do not improve, suffer an adverse reaction or deteriorate.

Veterinary surgeons should provide this service within an appropriate timeframe depending on the circumstances, which could be immediately. 

The general rule under the new guidance is that whether a physical examination is required prior to prescribing POM-Vs is a matter of judgement for the veterinary surgeon taking into account the factors set out in the guidance.

However, there are some notable exceptions to this rule:

a. When a notifiable disease is suspected.

b. When prescribing antibiotics, antifungals, antiparasitics and antivirals (unless there are exceptional circumstances).*

c. When prescribing controlled drugs (unless there are exceptional circumstances).

*In terms of the proximity of physical examination to prescribing, the rules are slightly different depending on the species being treated [see paragraphs 4.17 (a), (b) and (c) of the guidance].

Under the new guidance, when a veterinary surgeon takes an animal under their care, they must be able, on a 24/7 basis, to physically examine the animal, or visit the premises in the case of production animals, equines, farmed aquatic animals and game.

Veterinary surgeons should also be prepared to carry out any necessary investigation in the event that animals taken under their care do not improve, suffer an adverse reaction or deteriorate. Veterinary surgeons should provide this service within an appropriate timeframe depending on the circumstances, which could be immediately. 

Where a veterinary surgeon is not able to provide this service [set out in paragraph 4.10 of the new guidance] 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. Veterinary surgeons should provide clients with full details of this arrangement, including relevant telephone numbers, location details, when the service is available and the nature of service provided.

The aim of this provision is to ensure that animals always have somewhere to go if needs be, for example, if the issue cannot be dealt with remotely, their condition deteriorates, or they have an adverse reaction to any medicines prescribed remotely.

This requirement was added in response to concerns that allowing remote prescribing might enable online only businesses to prescribe medicines to animals without any ‘back up’.

Apart from the clear animal welfare issue, there was also concern that this would put pressure on physical practices asked to deal with any adverse consequences arising from interventions by remote-only prescribers.

Due to the overarching requirement to provide 24-hour emergency first-aid and pain relief, the new 24/7 in-person care requirement should not place any additional burden on existing organisations providing clinical services.

Instead, it ensures that businesses, which may not operate during normal working hours or have a physical premises, cannot take an animal under their care and prescribe POM-Vs without having appropriate follow-up care in place should it become necessary.

We realise that there are differences in opinion within the profession regarding the inclusion of antiparasitics in this part of the guidance.

There are a range of factors set out in the guidance to be taken into consideration when prescribing POM-Vs, and we understand that the opinion of some is that these can simply be applied to antibiotics and antiparasitics to ensure responsible prescribing.

However, it is our view that these medicines should be treated differently to other POM-Vs because the risk of uncontrolled use is greater, for example, resistance and environmental impact.

As such, the guidance requires a physical examination in order to positively impact prescribing behaviours and change attitudes to these medicines.

Yes, so long as a physical examination is carried out at the time the prescription is made.

Please note that because the new guidance requires that a physical examination is carried out at the time of prescribing antiparasitics, a prescription for the whole period to be covered should be made at the time of the physical examination and include directions on how much should be dispensed and when, for example, a 12-month prescription to be dispensed at quarterly or monthly intervals.

Last updated: 9 February 2024

No, this guidance only relates to the prescription of prescription-only veterinary medicines (POM-Vs).

Although this guidance does not cover POM-VPS, these should of course be prescribed responsibly and in line with the requirements of the Veterinary Medicines Regulations (VMRs). 

Given the unique challenges of treating wildlife, the Standards Committee has decided that groups of wildlife brought into wildlife centres may be treated as an exception to the general rule contained within paragraph 9(a) of the new guidance, which says a physical examination should be carried out at the time of prescribing.

Instead, the Committee’s view was that they may be treated in a similar way to production animals [see paragraph 9(b) of the new guidance]. The basis for this being that wild animals should be kept at the centre for as short a time as possible with handling kept to a minimum and, once released, cannot be monitored to 'see how they go'.

We are also mindful that depending on the circumstances, releasing animals without treatment might cause additional problems in the species population.   

In practice, this means that when prescribing antimicrobials for wildlife in rescue centres the veterinary surgeon does not have to examine the specific animal being prescribed for, but does need to have attended the premises and examined at least one representative animal recently enough to have current information and knowledge.

They also need to have an in-depth knowledge of the premises, the local environment and disease challenges in the area.

Whether attendance at the premises/examination of one representative animal has occurred 'recently enough' will depend on the circumstances in any given case, for example the nature of the condition, the medication being prescribed and whether the health status of the wider group or disease challenges have, or may have, significantly changed since the previous visit to the premises.

In this respect, what is 'recently enough' for the purpose of prescribing antiparasitics is unlikely to be appropriate when prescribing antibiotics, for example.

In any event, the prescribing vet would have to ensure they had enough current information and knowledge to prescribe responsibly and effectively.

Yes. In line with the RCVS’s guidance on mutual clients, if any vet becomes aware that an animal they are treating is registered with another vet, clinically relevant information should be shared.

Alleged breaches of this guidance will be investigated and enforced in the same way as breaches of any part of the guidance and/or Code of Professional Conduct. More information about our investigations process can be found in our concerns section.

If members of the profession have concerns that a colleague is not following this guidance but are not sure how to proceed, they may contact the RCVS advice team to discuss the issue and any next steps.

Depending on the circumstances, the advice team may be able to issue formal advice to the veterinary surgeon in question reminding them of their obligations under this guidance and the Code of Professional Conduct. This conversation will be kept confidential and the professional seeking advice may remain anonymous if they so wish.

Professionals may also seek advice from our confidential reporting line, which allows veterinary professionals, including veterinary surgeons, veterinary nurses and other members of the veterinary team to have informal, confidential, discussions with members of the Professional Conduct Department about potential fitness to practise issues, short of formally raising a concern.

However, if a decision is taken to raise a formal concern about a veterinary surgeon or nurse, the person raising the concern will generally need to identify both themselves and the individual they wish to raise concerns about in order to take it through our investigation process.

Please note: there is a streamlined process for veterinary surgeons and nurses to raise concerns with us.

Veterinary surgeons who provide veterinary services to animals in the UK are considered to be practising in the UK regardless of where there are physically based. This means that they must be an MRCVS on the 'UK-practising' category of the RCVS register, keep up to date with Continuing Professional Development (CPD) and have professional indemnity insurance (PII).

Even where a vet is properly registered, has completed CPD and has PII in place, there are still a number of barriers before POM-Vs could be prescribed from overseas as set out below. 

Under the new guidance, any vet who takes an animal under their care, must be able, on a 24/7 basis, to physically examine it and carry out any necessary investigations. This service should be provided within a reasonable timeframe, which could be immediately.

Clearly, veterinary surgeons based abroad would not be able to fulfil this obligation themselves and so they, or the company they are working for, would have to find a veterinary provider, based in the UK to provide this service.

It is the veterinary surgeon’s responsibility to make any such arrangement (it is not enough that the animal is registered at another practice) and it must be made in advance before veterinary services are offered with the terms confirmed in writing.

If the business is based online and clients are able to contact it from anywhere in the UK, they would have to ensure that the provision of 24/7 follow-up arrangements was available to all clients using their service.

Finally, even if an MRCVS based overseas was able to fulfil their obligations in terms of 24/7 follow-up care, they would not be able to supply any prescribed medicines. Under the Veterinary Medicines Regulations, these may only be supplied from Registered Veterinary Practice Premises, which, due to inspection requirements, can only be registered in the UK.

Yes. This guidance will be reviewed by RCVS Council after it has been in place for 12 months.

We would therefore welcome any information or evidence that will assist with informing this review so that Council has as complete a picture as possible.

Please contact the advice team at [email protected]  

Your legal obligations when prescribing POM-Vs

In line with the VMRs, POM-Vs may only be supplied where there is a valid prescription by a veterinary surgeon who has carried out a clinical assessment and has the animal under their care.

There is no specific form for a prescription: it can be oral, written as a script for the client to take away or written in the notes.

However, whatever form it takes, a prescription needs to include enough information so that the person supplying against it knows what to do, whether they are another veterinary surgeon, a pharmacist, RVN, SQP or lay member of staff.

With this in mind, the VMRs specify the information that written prescriptions must include (see paragraph 6 of Schedule 3) and templates are available from veterinary associations such as BSAVA and BEVA.

Records of oral prescriptions in clinical records

For oral prescriptions noted in the clinical records, much of the required information will already be available, for example, name and address of owner, animal identification, or will be added automatically, for example, veterinary surgeon’s details, authentication of the prescriber).

Where this is the case, there is no need to repeat this information under the heading 'prescription' or add it to the prescriptions tab on the practice management system.

In addition, some information may not be relevant, for example, withdrawal period or cascade use.

However, to be a valid prescription, the veterinary surgeon will need to include details of the medication they are prescribing as follows:

a. the product name

b. the pack size/volume/quantity of the product

c. the dosage instructions

d. any necessary warnings or instructions

e. either a frequency and time period, eg ‘1 bottle a month for the next 3 months’, or a number of repeats, eg ‘can be repeated twice’

f. an end time for the repeats, eg the decision on when you next want to see the animal

g. any other information you consider relevant

In view of this, entries in the notes such as 'OK for endos and ectos' or 'Recommend fleas and wormers for the next 12 months' are not valid prescriptions and supplying POM-V antiparasitics against this kind of entry does not comply with the VMR.

Generics and alternatives

The RCVS and VMD do not recommend noting prescriptions as mg/kg due to possible errors being made when the dose is calculated. However, where the generic active ingredient is prescribed in mg/kg, the prescribing vet will need to authorise this prior to the product being dispensed.

Generally, recording alternative or contingent prescriptions in the notes is not acceptable. However, for situations where listing one alternative might be appropriate, please see joint guidance published by the RCVS and Veterinary Medicines Directorate (VMD).

Further guidance

Further guidance on prescribing and supplying veterinary medicines is provided by the Veterinary Medicines Directorate.

If you have any concerns arising from the above information, please contact our advice team on 020 7202 0789 or [email protected].

Last updated: 9 February 2024