5. What is the requirement to provide 24/7 in-person care?

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].

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.