19. Treatment of animals by unqualified persons

Introduction

19.1  The purpose of this guidance is to explain the restrictions that apply under the Veterinary Surgeons Act 1966 (‘the Act’) to ensure that animals are treated only by those people qualified to do so. These restrictions apply where the ‘treatment’ is considered to be the practice of ‘veterinary surgery’, as defined by the Act.

19.2  Section 19 of the Act provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practise veterinary surgery. 'Veterinary surgery' is defined within the Act as follows:

‘“veterinary surgery” means the art and science of veterinary surgery and medicine and, without prejudice to the generality of the foregoing, shall be taken to include:

a.  the diagnosis of diseases in, and injuries to, animals including tests performed on animals for diagnostic purposes;

b.  the giving of advice based upon such diagnosis;

c.  the medical or surgical treatment of animals; and

d.  the performance of surgical operations on animals.’

19.3  A number of exceptions apply which can be found in the Act itself (Schedule 3), as well as in the form of specific exemption orders.

19.4  Veterinary surgeons and veterinary nurses should be aware of the exceptions as they apply, for example, to:

a.  the animal owner, a member of their household or their employee, who may carry out minor medical treatment, in accordance with Schedule 3 of the Act;

b.  the animal owner or person engaged in caring for animals used in agriculture, who may carry out medical treatment or minor surgery not involving entry into a body cavity, in accordance with Schedule 3 of the Act;

c.  registered veterinary nurses who may carry out medical treatment and minor surgery (not including entry into a body cavity), in accordance with Schedule 3 of the Act (see supporting guidance on delegation to veterinary nurses);

d.  student veterinary nurses who may carry out medical treatment and minor surgery (not including entry into a body cavity), in accordance with Schedule 3 of the Act (see supporting guidance on delegation to veterinary nurses);

e.  veterinary students who are undertaking the clinical part of their course, in accordance with the Veterinary Surgeons (Practice by Students) (Amendment) Regulations 1993;

f.  registered farriers in accordance with the Farriers (Registration) Acts 1975 and 1977;

g.  persons providing physiotherapy in accordance with the Veterinary Surgeons (Exemptions) Order 2015

h.  blood sampling under the Blood Sampling Order 1983, as amended;

i.  animal husbandry trainees over 17 years of age in castration of certain male animals, disbudding of calves and docking of lambs' tails, in accordance with Schedule 3 of the Act; and,

j.  anyone administering emergency first aid to save life or relieve pain or suffering, in accordance with Schedule 3 of the Act.

Veterinary students

19.5  Veterinary students, as part of their clinical training, are required to undertake acts of veterinary surgery.

19.6  The Veterinary Surgeons (Practice by Students) (Amendment) Regulations 1993 identify two categories of student, full-time undergraduate students in the clinical part of their course and overseas veterinary surgeons whose declared intention is to sit the RCVS Statutory Examination for Membership within a reasonable time. The Regulations provide that students may examine animals, carry out diagnostic tests under the direction of a registered veterinary surgeon, administer treatment under the supervision of a registered veterinary surgeon and perform surgical operations under the direct and continuous personal supervision of a registered veterinary surgeon.

19.7  The RCVS has interpreted these as follows:

a.  'direction' means that the veterinary surgeon instructs the student as to the tests or treatment to be administered but is not necessarily present.

b.  'supervision' means that the veterinary surgeon is present on the premises and able to respond to a request for assistance if needed.

c.  'direct and continuous personal supervision' means that the veterinary surgeon is present and giving the student their undivided personal attention.

Unqualified (or ‘lay’) practice staff

19.8  Many veterinary practices employ staff who are not veterinary surgeons, veterinary nurses or student veterinary nurses. Regardless of any training or experience these staff members may have, in the context of the veterinary practice, such staff should be regarded as unqualified or laypeople. Their job titles should not be misleading and should reflect their demarcation from qualified members of staff. In particular, veterinary surgeons and veterinary nurses should not hold out a colleague as a ‘veterinary nurse’ unless that colleague is appropriately registered with the RCVS.

19.9  The RCVS recognises that veterinary surgeons may wish to delegate certain tasks to unqualified members of staff. There is no specific legal dispensation in the Veterinary Surgeons Act for a veterinary surgeon to delegate to a layperson employed by a veterinary practice. This means that unqualified members of staff have no legal dispensation to undertake delegated medical treatments or minor surgical procedures, regardless of how well trained or experienced they are considered to be.

19.10  In the absence of any legal basis for such delegation, and with the aim of preserving animal welfare, the RCVS advice is that any delegation to a lay member of staff needs to be justified and is a matter of professional judgement in any individual case following risk assessment. The delegation should:

a.  Be reasonable in all the circumstances;

b.  Not put the animal at risk; and

c.  Not amount to more than ‘minor medical treatment’ of the sort which an owner could undertake, for example, the administration of uncomplicated oral medications or subcutaneous injections.

19.11  The delegation of veterinary procedures, even ‘minor medical treatment’, will involve consideration of all the circumstances, not just the procedure itself. The delegating veterinary surgeon should therefore have regard to the following:

a.  the nature of the task (i.e. its level of complexity);

b.  the individual animal concerned (i.e. species, its condition, the likelihood of complications, the owner’s wishes);

c.  the individual staff member (i.e. their training and experience, their confidence and willingness to accept delegation, their awareness of when to seek the assistance of a qualified colleague); and

d.  the availability of qualified assistance.

19.12  The RCVS considers that there are certain tasks that should not be delegated to unqualified members of staff; examples include intramuscular or intravenous injections, and invasive procedures such as the introduction of an IV catheter or the passage of a urinary catheter.

19.13  Veterinary surgeons should generally ensure that the client is made aware of any procedures to be performed by practice staff who are not veterinary surgeons, where appropriate.

19.14  The directing veterinary surgeon remains responsible for their decision to delegate to unqualified members of staff. Should a delegation decision become the subject of a professional conduct investigation, the RCVS would consider the reasonableness of the veterinary surgeon’s decision. A clearly-reasoned and recorded decision should therefore be behind every delegation to an unqualified member of staff. 

Farriers

19.15  Both veterinary surgeons and farriers are involved in the treatment of horses' feet. While veterinary surgeons are exempt from the restrictions in the Farriers Registration Acts 1975 and 1977, farriers are not exempt from the restrictions in the Act, and may not carry out procedures deemed to be acts of veterinary surgery.

19.16  There is no clear demarcation line between veterinary surgeons and farriers in the exercise of their professional responsibilities, so that much depends on individuals and the relationship between them. Decisions as to whether a particular procedure should be performed by one or the other are a matter for consultation and cooperation. Veterinary surgeons should make every effort personally to discuss cases with farriers.

19.17  Farriery consists of trimming and balancing the equine hoof prior to and for the fitting of conventional or surgical shoes, and where a veterinary surgeon requires particular work from a farrier, this should be specified in personal contact between them.

19.18  A farrier must not normally penetrate sensitive structures, cause unnatural stress to the animal, make a diagnosis or administer drugs. If they feel that either the veterinary surgeon is treating the animal incorrectly, or that a further condition is present requiring treatment, they should notify the veterinary surgeon or advise the owner to call in the veterinary surgeon. If a veterinary surgeon considers that a farrier's work is inadequate they should contact the farrier directly. Neither should make detrimental comments about the work of the other unless in the course of a formal complaint to their regulatory bodies: the Royal College of Veterinary Surgeons and the Farriers Registration Council.

Physiotherapy, Osteopathic Therapy and Chiropractic Therapy

19.19  Musculoskeletal therapists are part of the vet-led team. Animals cared for or treated by musculoskeletal therapists must be registered with a veterinary surgeon. Musculoskeletal therapists carry out a range of manipulative therapies, including physiotherapy, osteopathy and chiropractic therapy. 

19.20  As per the Veterinary Surgeons (Exemptions) Order 2015 (which revokes the Veterinary Surgery (Exemptions) Order 1962) remedial treatment by ‘physiotherapy’ requires delegation by a veterinary surgeon who has first examined the animal. The Order allows the treatment of an animal by physiotherapy if the following conditions are satisfied:

(1) the first condition is that the person providing the treatment is aged 18 or over

(2) the second condition is that the person is acting under the direction of a qualified person who—

(a) has examined the animal, and

(b) has prescribed the treatment of the animal by physiotherapy.

19.21  The Order specifies that a qualified person “means a person who is registered in the Register of Veterinary Surgeons or the Supplementary Veterinary Register”.

19.22  'Physiotherapy' is interpreted as including all kinds of manipulative therapy. It therefore includes osteopathy and chiropractic but would not, for example, include acupuncture or aromatherapy. It is up to the professional judgement of the veterinary surgeon to determine whether and when a clinical examination should be repeated before musculoskeletal treatment is continued.

19.23  The delegating veterinary surgeon should ensure, before delegation, that they are confident that the musculoskeletal therapist is appropriately qualified and competent; indicators can include membership of a voluntary register with associated standards of education and conduct, supported by a disciplinary process. As the RCVS does not regulate musculoskeletal therapists it cannot recommend specific voluntary registers.

19.24   Musculoskeletal maintenance care for a healthy animal, for instance massage, does not require delegation by a veterinary surgeon. However, the animal must still be registered with a veterinary surgeon. Maintenance should cease and the owner of the animal should be asked to take their animal to a veterinary surgeon for clinical examination at the first sign that there may be any underlying injury, disease or pathology. Alternatively, the musculoskeletal therapist may ask the client for formal consent to disclose any concerns to the veterinary surgeon that has their animal under their care.

Other complementary therapy

19.25  It is illegal, in terms of the Act, for non-veterinary surgeons, however qualified in the human field, to treat animals. All forms of complementary therapy that involve acts or the practise of veterinary surgery must be undertaken by a veterinary surgeon, subject to any exemption in the Act. At the same time, it is incumbent on veterinary surgeons offering any complementary therapy to ensure that they are adequately trained in its application.

'Anaesthesia-free dental procedures' for cats and dogs

19.26  Lay people may be involved in providing grooming services for animals and should be aware of the statement on 'Anaesthesia-free dental procedures' for cats and dogs, supported by the RCVS Standards Committee (see 'Related documents' box).