Letter from the President: remote prescribing and workforce shortages

Dear Colleague,

Remote prescribing

In July, I wrote to let you know that the Standards Committee had decided to extend the operation of our temporary guidance on remote prescribing until 30 September 2021. The Committee had hoped that, by this time, the effects of the pandemic would have become more manageable, and practices would be under less pressure, as a result.

Unfortunately, this does not seem to be the case, with practices and employers telling us that the pandemic continues to impact veterinary teams and provision of services.

On top of this, we have seen a recent spike in cases in Scotland following the return to school, which we expect to see mirrored across the rest of the UK, and are aware that the UK Government has included the possibility of requiring people to work from home as part of its ‘Plan B’ measures if high rates continue.

Consequently, the Standards Committee has this week decided to extend the operation of the temporary guidance on remote prescribing for a further month, until midnight on 31 October 2021.

The temporary derogation remains subject to the specific guidance found in FAQ4, including that you must be able provide a 24/7 follow-up service involving physical examination, for example where the animal does not improve, or suffers an adverse reaction, or deteriorates, subsequent to the remote prescription of medicines.

As previously, the Committee will continue to monitor the ongoing effects of the pandemic and keep this position under review.

Workforce shortages

Throughout the pandemic, veterinary surgeons and veterinary nurses have done an exceptional job in continuing to provide veterinary care for the nation’s animals during extremely difficult circumstances.

Whilst Covid conditions continue to be challenging, we are very aware that the professions continue to face additional difficulties, particularly in meeting demand for services with a reduced workforce during what is a very busy time.

Background

The reasons for the current veterinary workforce shortage are complex and, while already in existence to a certain extent prior to the outbreak, have been exacerbated by a number of factors in the last 18 months.

These include a reduction in the number of overseas-qualified veterinary surgeons to enter the UK workforce since EU Exit; the impact of the pandemic on the available veterinary workforce due to illness, burnout and fatigue; and, the reported increase in pet ownership during lockdown with a knock-on increase in demand for veterinary services.

We appreciate the additional pressure these shortages are placing on already-stretched veterinary teams at the moment, for the provision of both routine treatment during normal working hours and emergency cover out of hours.

Support

In the face of current shortages, I would like to stress that we support practice teams in prioritising cases strictly according to the health and welfare needs of their patients, and in informing their clients of the need to do so,

We would also urge veterinary surgeons to share their caseload as much as possible, delegating permitted procedures to their veterinary nurse colleagues wherever appropriate to do so.

And, we would like to remind veterinary surgeons that their current 24/7 emergency cover obligations, as set out in the RCVS Code of Professional Conduct, are limited only to taking steps to provide 24-hour emergency first-aid and pain relief to animals according to their skills and the specific situation.

To help with different situations that may encountered at the moment, particularly around the provision of 24/7 emergency cover, and to provide further guidance on delegating procedures to veterinary nurses, we have provided some FAQs (below).

Concerns

Finally, we understand the worry amongst veterinary professionals who may feel they are currently unable to offer the level of service they would like to and who may be anxious about the potential for an increase in associated concerns raised by clients with the RCVS at the present time.

In all situations, but particularly during this very busy time, we would urge veterinary professionals to rely on their professional judgement, to act reasonably in the circumstances, and to ensure they can justify their actions and decisions via the recording of detailed contemporaneous notes.

Although we do have a responsibility to investigate any concern that is raised with us, we will always consider the entire circumstances of the case, including any attempts to meet Code requirements.

We will also continue to raise awareness amongst animal owners of the acute challenges currently facing veterinary teams around the country, and to request their ongoing patience and understanding.

Thank you

On behalf of RCVS Council, I should again like to thank you for your ongoing hard work and commitment to maintaining the health and welfare of our animals during these difficult days.

We will continue to review the latest situations around both Covid restrictions and workforce shortages and keep you up to date with our latest guidance.

In the meantime, our review of under care and provision of 24/7 emergency cover is due to report later this year, and we are currently organising a summit with employers and veterinary/veterinary nursing organisations to explore innovative ways to tackle the workforce shortages.

Yours sincerely

Dr Kate Richards BVM&S MRCVS

President

1. The out-of-hours (OOH) service my practice uses has notified us this morning that they will not be open tonight due to staffing issues and that for tonight they are diverting our clients to their next nearest branch, which is further away. Am I still meeting my OOH obligations to provide emergency first aid and pain relief?

If you have a pre-existing arrangement with a dedicated emergency service, but that service is temporarily directing clients to the next nearest emergency care provider due to staffing issues, you are still fulfilling your obligations under the Code, in that you have taken steps to provide emergency first aid and pain relief.

The RCVS does not dictate a maximum travel time/distance for clients to use an emergency service, because circumstances vary. However, you should ensure that clients are only expected to travel reasonable distances and that the service’s own response times are reasonable. What is considered reasonable will be influenced by local conditions and geographical factors.

When reasonably practicable to do so, you should notify your clients that your OOH arrangements have changed, and explain how it may affect the service that they receive. You could do so, for example, via social media, on your website, or on the phone auto attendant system.

You should avoid directing clients to a more local 24-hour emergency service if you do not have a pre-existing arrangement with that practice. However, if you consider (as above) that your clients are having to travel an unreasonable distance to access OOH care, you may either contact local OOH providers to come to a temporary arrangement or provide the care yourself.

We understand that neither of these options may be workable due to staffing issues, but you should do all you can to meet your Code obligations, and comprehensively document where this has not been possible together with the reasons why. We do have a responsibility to investigate any concern that is raised with us; however any investigation would consider the full context in which decisions were made.

Please note that the requirement to take steps to provide a 24-hour service extends only to emergency first aid and pain relief – the intention is to attend to the initial and essential welfare needs of the animal, in particular, to relieve pain and suffering. If a client contacts you with concerns that an animal needs emergency attention, you should decide and advise whether attention is required immediately, or can reasonably be delayed.

2. I work for a practice that provides its own OOH services. There is a dedicated OOH provider nearby that is used by other local practices, but it has had to close due to staffing issues. Many of the clients who would use that OOH provider are coming to us as a result, what are my obligations?

If the animal owner requesting an emergency consultation is a client of another veterinary surgeon or practice, you may turn them away and redirect them to that veterinary surgeon or practice (or the emergency service provider for that veterinary surgeon or practice).

However, first-aid and pain relief must be provided to the animal if, for whatever reason, the owner cannot contact their usual veterinary surgeon or practice or the circumstances are exceptional, and the condition of the animal is such that it should be seen immediately.

Fees are a matter for the practice to decide, and as such, it is at the discretion of the practice if a premium is charged for seeing non-clients.

You should discuss likely costs and arrangements for payment with the client at an early stage, however immediate first-aid and pain relief should not be delayed while financial arrangements are agreed.

3. I work for an out of hours (OOH) provider and due to staff shortages today, we cannot open. We are temporarily diverting clients to the next nearest OOH provider, which means they have to travel further than usual. Is this ok?

Any 24-hour emergency care provider should ensure that the staffing, facilities, and arrangements are appropriate to the likely workload of the practice.

These should be reviewed on an ongoing basis to ensure that the 24-hour emergency cover provision remains appropriate and adequate.

The RCVS does not dictate a maximum travel time/distance for clients to use an emergency service, however you should ensure that clients are only expected to travel reasonable distances when diverting clients to alternative practices.

What is considered reasonable will be influenced by local conditions and geographical factors.

If your practice is unable to provide the service for which they are contracted due to staff shortages, and cannot direct clients to another branch within a reasonable distance, you should inform the practices with which you have an arrangement to provide this service as soon as possible, to allow them to make alternative arrangements where possible [see FAQ 1].

The situation should be contemporaneously documented, including attempts to hire staff, in case of any subsequent concern being raised with the RCVS.

4. To help with staff shortages, I would like to delegate more work to our veterinary nurse team. What are they allowed to do?

Under Schedule 3 to the Veterinary Surgeons Act, registered veterinary nurses and student veterinary nurses are permitted to perform certain procedures in veterinary practice, as delegated to them by veterinary surgeon colleagues employed in the same practice.

To help understand the provisions of Schedule 3, please view our guidance, case studies and other resources.