Finding a pragmatic approach to 24-hour cover

Following a consulation earlier this year on draft guidance for the provision of 24-hour emergency cover in remote regions, Council approved new guidance at its meeting yesterday.

Overall, members supported the provision of 24-hour emergency cover, and advocated adopting a pragmatic approach in regions where comprehensive 24-hour emergency cover might not be possible. We were grateful for the useful comments we received from members in both rural and urban areas, but what revisions has Council agreed?

Following our consultation, the 24-hour Emergency Cover Working Party (24/7 WP) met again in April to consider members' responses on our proposed guidance for remote regions and to make recommendations for revised guidance on other aspects of emergency cover. The following recommendations were then considered by Advisory Committee later that month and agreed by Council in June.

Remote regions - a pragmatic approach

Our consultation was mainly concerned with developing a non-exhaustive list of factors to consider when determining whether a veterinary surgeon's 'steps to provide 24-emergency cover' in remote regions were reasonable.

Veterinary surgeons working in such areas emphasised that they did so by choice and that those who lived and worked there accepted the limitations of certain services. A pragmatic approach had therefore already developed.

The main concern of both the 24/7 WP and the Advisory Committee was to clarify that the revised guidance applied only to those geographical areas where, '… for logistical reasons, travelling may be difficult and may be influenced by inclement weather, ferries or other factors'.

Council agreed that this definition would differentiate remote areas from those where there was a low stock/animal density (where although veterinary surgeons might be available, they might not necessarily have the relevant expertise for the particular species presented).

Home visits

The 24/7 WP also considered revised guidance on the duty of care regarding home visits to take into account not only the safety implications (for the veterinary surgeon) of making a visit, but also factors for veterinary surgeons to consider when deciding whether to attend an animal away from the practice premises.

The guidance also makes clear that practice policies to exclude emergency visits are not acceptable and a veterinary surgeon should assess each request individually.

Travelling time

During our last review of travelling time, in 2005, it was decided that we could not specify a distance or time that was acceptable to obtain emergency veterinary services, as this would be influenced by local conditions.

The 24/7 WP highlighted the importance of making available to clients good practice information about the 24-hour emergency cover arrangements in place, and noted the reminder published in RCVS News (March 2007).

Our existing guidance states that veterinary surgeons 'must be able to demonstrate that they have made arrangements, in advance, to provide 24-hour emergency cover for all their clients'.

The 24/7 WP's view was that when making these arrangements, both the primary-care veterinary surgeon and the out-of-hours provider had a duty to consider whether the arrangements between them were workable. In so doing, both parties should ensure that:

• clients are expected to travel only reasonable distances;
• information on the 24-hour emergency cover arrangements is available to clients; and,
• when entering into arrangements to provide 24-hour emergency cover for another practice, confirmation is attained that that practice's clients will be informed of the agreed arrangements.

Particular species

The 24/7 WP also considered whether our current guidance in Part 1C (paragraph 1,c,ii) was sufficient for situations in either rural or urban areas where there was inadequate veterinary cover for a particular species.

It felt that this guidance was unrealistic and that the provision's intention was actually to ensure veterinary surgeons facilitate emergency assistance from a veterinary surgeon with knowledge and experience of that species.

Whilst veterinary surgeons could not be expected to provide pain relief for all species, they could be expected to facilitate the provision of first aid. Council therefore approved the following amended guidance:

'veterinary surgeons must not unreasonably refuse to provide first aid and facilitate in the provision of pain relief for all other species'.

Paragraph 1,c,iii of that section continues to provide that other on-duty veterinary surgeons providing 24-hour emergency cover must 'not unreasonably refuse to accept responsibility for an animal from a colleague, in order to provide first aid and pain relief for that animal'.

Referral practitioners

Finally, the 24/7 WP also considered our current guidance on the provision of 24-hour emergency cover by referral practitioners, which had been revised during the last review. It considered that while the intention might have been to enhance the 24-hour emergency cover provided by referral practices, the revision had actually had the opposite effect.

The 24/7 WP therefore recommended that the previous wording be reinstated (to ensure that 24-hour emergency cover is provided on a general basis and not just for referred patients), with the addition that if directing a referring veterinary surgeon to 'an alternative source of assistance', that assistance should be available by 'prior arrangement'.

In addition, the WP felt that referral practitioners should make provision for post-operative patient care to standards similar to their own, unless agreed with the client.

The amended annex is now available in the online Guide or a hard copy can be obtained from the Professional Conduct Department (020 7202 0789 or [email protected]).