LWP update 1: assuring practice regulation

During July and August, Vet Record is publishing a series of features about the key recommendations contained in the recent report of the RCVS Legislation Working Party (LWP), from some of those who were directly involved in making them. To start, lay member of RCVS Council Claire McLaughlan (pictured below) discusses the LWP’s recommendations around the principle of assuring practice regulation.

The original article is reproduced below with kind permission of Vet Record.

The RCVS Legislation Working Party

The LWP’s recent report contained a series of recommendations on the shape of the future legislation governing the veterinary professions and the principles that would underpin this legislation. The recommendations included the need for greater clarity, the incorporation of the entire vet-led team under one regulatory banner, introducing greater flexibility and future proofing the legislation.

The LWP was set up in 2017 to consider the principles governing any new legislation affecting veterinary regulation, and to develop recommendations for future replacement of the Veterinary Surgeons Act 1966. The group comprised members of RCVS council, RCVS staff and representatives from the BVA and the British Veterinary Nursing Association, and has also made extensive use of external advice from other regulators and experts.

Chair of the LWP Stephen May reported the group’s broad recommendations to RCVS council in June, following which council voted to put them forward for a comprehensive consultation of the professions and the public later this year. The consultation feedback will then be considered further by the college before any final proposals are adopted.

Mandatory practice standards

Among the principles used by the LWP was that any new legislation should provide clarity to the public and enhance public confidence in the professions. One way that we can do this is by ensuring that all veterinary practices are assessed to ensure they are meeting the minimum legal and regulatory standards.

The RCVS Practice Standards Scheme (PSS) has been very successful in assuring standards, and a recent ‘reboot’ of the scheme has increased membership to 68 per cent of veterinary practices.

When the PSS was first launched in 2005, it was noted that while it could only be a voluntary scheme without a change to the Veterinary Surgeons Act, consultation with the profession revealed an overwhelming preference for a mandatory scheme.

For as long as it remains a voluntary scheme, however, there is no mechanism to ensure standards across all practices through assessments. Unlike other sectors, there is no body responsible for regulating veterinary practices.

At present, the RCVS only regulates individual veterinary surgeons and nurses, unlike modern regulatory regimes such as that recently established for the General Pharmaceutical Council, which has an outcome-based scheme conducted via unannounced inspections with published results for full transparency and a focus on sharing best practice.

In human healthcare, the Care Quality Commission (CQC) fulfils this role, monitoring, inspecting and regulating services (hospitals, GP practices, care homes, dentists, ambulances and mental health services) to make sure they meet fundamental standards of quality and safety and publishing findings, including performance ratings, to help people choose care.

Some overseas veterinary regulators such as the Veterinary Council of Ireland (VCI) have this responsibility – the VCI grants ‘Certificates of Suitability’ for veterinary premises and has an accompanying inspection regime.

The RCVS currently has no mandatory powers to regulate veterinary practices. This is increasingly at odds with a world in which practices may not be owned by the individual veterinary professionals whom the college does regulate.

It is reasonable for the public to expect that all practices are assessed to ensure that they meet at least the basic minimum legal requirements, and at present this assurance is not in place for all practices.

It is well understood that there are many excellent practices that are not members of the PSS, but it is the role of a regulator to assure and uphold standards – it cannot merely assume them.

A 2019 survey of pet owners found that over 93 per cent of respondents considered that accreditation was an important factor in choosing a practice, and a majority believed that the scheme should be mandatory.

While non-PSS practices might be meeting core standards, there is no guarantee or public assurance that this is the case, and this gap is not consistent with our aims for animal welfare and public protection. It is well understood that there are many excellent practices that are not members of the PSS, but it is the role of a regulator to assure and uphold standards – it cannot merely assume them.

The RCVS has sought to address this by making the scheme’s ‘core standards’ a requirement under the RCVS Code of Professional Conduct (see below). However, as the Code only applies to individual veterinary professionals, this does not necessarily sit easy with responsibilities at practice level where individuals will have varying degrees of control over practice decisions and policies, and therefore creates a greater responsibility for more junior members of staff than might be considered reasonable.

The LWP has therefore recommended that the RCVS be given the power to implement mandatory practice regulation should RCVS council decide, following the consultation, to complement the PSS with a universally applied scheme.

Any mandatory scheme could look somewhat different from, and sit alongside, the existing PSS scheme, and use different approaches. For example, it could include the use of ‘improvement notices’ when a person or a business is failing to fulfil a legal or regulatory duty, and where improvement is required to ensure that standards are met in future.

This would provide better protection for the public, while being a more proportionate response than pursuing a disciplinary case. Improvement notices provide practices with a clear and concrete action plan to remedy any deficiencies.

Powers of entry

The College has no ‘power of entry’, meaning it does not have the right to enter a veterinary practice without consent.

In most cases, this does not pose a problem in terms of investigating allegations of serious professional misconduct against an individual. However, where there are allegations that a veterinary surgeon has breached paragraph 4.3 of the RCVS Code of Professional Conduct, which states that ‘veterinary surgeons must maintain minimum practice standards equivalent to the Core Standards of the RCVS Practice Standards Scheme’, powers of entry would be useful.

This is because, if a veterinary surgeon refuses entry, it is extremely difficult, if not impossible, for the college to investigate allegations of this nature. The LWP believes that there is a strong argument that this is unacceptable from a public protection perspective.

While it is rare for other professional regulators to have powers of entry, the CQC does and may carry out unannounced inspections of hospitals, GP practices, care homes, dentists, ambulances and mental health services.

The LWP has therefore recommended that the RCVS be given powers of entry in order to remedy this omission in the veterinary sector, and to ensure that regulation of practices can be underpinned and enforced.

About the author

Claire McLaughlan is an independent consultant undertaking a portfolio of assignments in the NHS and private health sectors.

Most of her work involves individual and team performance management; she provides advice, support and action planning and undertakes investigations, reviews and inquiries.

Originally trained as a nursing officer in the Royal Navy, specialising in intensive care and health professional education, McLaughlan then studied law and qualified as a barrister in 2005. She became head of fitness to practise at the Nursing and Midwifery Council before she moved to the National Clinical Assessment Service becoming, most latterly, an associate director.

A member of NHS England’s Performance Advisory Groups and a chair of NHS England’s Performers List decision-making panels, she is also an invited review panellist for the Royal College of Paediatrics and Child Health.

McLaughlan was appointed to RCVS council in July 2018 for a four-year term, and joined the Legislation Working Party in February 2019.