We must review the meaning of 'under care'

This article was first published in the 16 November 2019 (Vol 185 No 19) edition of the Veterinary Record. We would like to thank the Veterinary Record for allowing us to reproduce the article on our website.

Everyone understands what ‘under care’ means, don’t they? At least, everyone understands what it means to them. After all, weren’t these words carved in tablets of stone in the Medicines Act 1968?

Except that ‘under care’ was not actually defined anywhere in the Act, or in the replacement Veterinary Medicines Regulations (2005), but has, over the years, been ‘interpreted’ by RCVS Council in the Code of Professional Conduct.

This, in essence, frames the fundamental challenge facing the College as it prepares to launch one of its most significant guidance reviews in many years. How should we continue to interpret ‘under care’ in a profession, and a society, that is largely unrecognisable to the one that first defined the term? How can we adapt this term to accommodate the different situations in which it is applied? Why do we want to review it at all?

I will return to the first two questions shortly, but to answer the third, we must revisit the joint RCVS/BVA Vet Futures initiative. One of its strategic ambitions was to review the regulatory issues relating to new veterinary technologies, with a view to establishing a framework to take account of future innovations.

The Vet Futures Report highlighted that there was ‘no limit to the impact that technological advances may have on the veterinary profession’, and noted that ‘it has been recognised…for some time that innovations in delivering healthcare in the veterinary sector will require changes to the regulatory framework to ensure animal health and welfare remain front and centre.’

The College then incorporated this ambition into its strategic plan, and launched a consultation in 2017 to seek views from all veterinary stakeholders on the use of telemedicine – using IT to provide healthcare remotely – in veterinary clinical practice, with a particular emphasis on ‘vet-to-client’ telemedicine.

The results revealed strong and diverse views. Confusion as to the existing parameters around remote consultations was also apparent, but there was little evidence on what the impact might be of any change to the supporting guidance to the RCVS Code.

As a result, the College devised mechanisms to gather such evidence, including a time-limited telemedicine trial. However, following lengthy and robust debates at both RCVS Standards Committee and RCVS Council meetings, it became clear that telemedicine, and specifically remote prescribing from vet to client, could not be considered in isolation.

What was really under the microscope was the meaning of ‘under care’, the associated rights and responsibilities, and how the principles applied in one veterinary sphere might, or might not, be applied in others. In addition, the College would need to be consistent in its approach to regulating all instances of under care, unless it could provide clear rationale for any difference.

RCVS guidance has certainly endeavoured to do this over the years, but inconsistencies and anomalies are apparent in the way ‘under care’ is being interpreted.

Therefore, it was decided that we needed a wide-ranging review, including a call for evidence. Which returns me to my first two questions. Indeed, we have recognised that this review will be so large and complex we need the support of an independent and specialist organisation to carry it out.

At the time of writing, we are waiting for full committee approval to proceed. The initial evidence-gathering stage will be the most complex, and will push back the proposed timeline for the review that we published earlier this autumn. Look out for more detail on this early in the new year, followed by updates on the analysis of the collated views, and then a consultation on a new draft of the guidance.

We will be seeking your views based not only on your own experience, but also on how this could apply across multiple sectors throughout the profession. We all have vested interests in this review. Only by receiving and reviewing as many different opinions as possible, will we know how best to apply the principle of ‘under care’ for the benefit of future generations of veterinary professionals and the animals for which they care.