Legislation Working Party

At this meeting the Legislation Working Party (LWP) was reminded that the Review of Minor Procedures Report had been signed-off by RCVS Council at its January meeting and submitted to the Department for the Environment, Food and Rural Affairs (Defra). The LWP was thanked for its work in contributing to this report.

The LWP discussed further work which has been undertaken around firming up proposals for a “veterinary nurse prescriber” role. In considering the proposals it reviewed an informal consultation on the role that had been carried out with a  small number of independent practices that had been identified via the Practice Standards Scheme, as well as the individual members of the Major Employers Group. This consultation looked at three proposals in more detail and sought views from these stakeholders on the feasibility of each model. The LWP also looked at the possibility of commissioning further evidence-gathering on potential risks associated with allowing VNs with appropriate extensive further qualifications and training to undertake vaccinations.

The LWP discussed the origins of the rule that procedures involving ‘entry into a body cavity’ could not be delegated to a veterinary nurse as well as the rules around delegation with respect to dental extractions and cat castrates. The LWP also discussed the possibility of uncoupling the requirement for a VN to be under the direct employment of a vet, noting that ‘working under direction’ was the key and that it was important to maintain consistency between VNs and proposals for other paraprofessionals.

There was also a wide-ranging discussion about the future of the College’s disciplinary process, following a comprehensive review of current RCVS procedures compared to those of other  healthcare regulators. The paper explored the primary purpose of regulation (ie to protect animals and the public, to declare and uphold professional standards, and to maintain confidence in the veterinary professions) and outlined a number of areas for discussion as regards the current disciplinary framework. The review noted that most healthcare regulators have a ‘forward looking’ approach to their disciplinary processes, in that the key question is whether a professional’s fitness to practise is currently impaired (known as the ‘fitness to practise’ model). The LWP intends to meet with colleagues from other healthcare regulators to better understand their experience of using the fitness to practise model, and will explore the use of nurse prescribers in human health at the same time.

The Legislation Working Party (LWP) spent some of this meeting reviewing progress around the draft Review of Minor Procedures Report to the Department of the Environment, Food and Rural Affairs (Defra). The LWP was thanked for all its work on this report, and reminded that it will be submitted to RCVS Council for its consideration at its January meeting. The Working Party recommended that any proposals around reform of the veterinary nursing profession should be the College’s first priority.

The LWP also discussed the outstanding issue of equine foot trimmers, noting that their work can be very varied. The LWP felt that the way forward could be to suggest to the Farriers Registration Council that they proceed, with support from the College as necessary, with pursuing the regulation of barefoot trimmers and other equine foot trimmers.

A paper was presented outlining the work achieved so far in expanding the role of VNs, including changes in the area of anaesthesia which have already been agreed in principle by RCVS Council. Proposals for a possible “veterinary nurse prescriber” role were being worked up and would be brought to the next meeting.

The LWP heard that the ViVet project, which looks at veterinary innovation, may be the suitable avenue for the proposed research into veterinary business models, and that this would then report into the Advancement of the Professions Committee. This could then be returned to the LWP for consideration once any potential legislative impact becomes clearer. Finally, the LWP was reminded that, with regards to veterinary surgeons working for companies and reporting to non-vets, the Code has been tightened up as much as possible within the frame of current legislation.

Items yet to be covered by the LWP from the list of outstanding issues identified with the 1966 Act, include registration and Disciplinary Committee issues, education and governance. These will be brought forward for discussion at future meetings.

For this meeting the Working Party welcomed former RCVS President Bradley Viner, who is Chair of the Exemption Orders and Associates Working Party, to this and future meetings to represent the work of the EO&AWP which has now made its recommendations. The Working Party also welcomed RCVS Council member Mandisa Greene as a practising vet representative on LWP.

The Committee heard that Sophie Rogers had recently been recruited as a new Innovation Executive, and as part of her work will be developing a proposal for research into different business and practice models in the veterinary sector.

Regarding proposals for a veterinary nurse practitioner role, three models of how these could operate were identified: a minimal model that only has responsibility for a preventative healthcare; a model which includes the ability to manage additional chronic conditions in stable patients; and a maximum model which includes the ability to provide first vaccinations in addition to the above.

In light of the responses to the first call for evidence and discussions, the LWP has decided to produce a paper and further informal consultation on the feasibility of the second model which includes the ability to provide preventative healthcare and help manage chronic conditions in stable patients. The LWP will also ask RCVS Knowledge to perform a literature search of findings on concurrent disease upon annual vaccination, ideally broken down by age and/or evidence gap in primary care research, as well as approaching both the BCVSp and MEG for data and advice. The LWP will also seek to identify independent practices to be included in any future informal consultation, perhaps via the Practice Standards Scheme (PSS).

The LWP also reviewed the work that had been completed by the EO&AWP since June 2017 when it reported on its work to RCVS Council. It also considered outstanding issues with the draft report to Defra on Exemption Orders. The LWP then spent some time reviewing the two models of regulation proposed for allied professionals which were approved by RCVS Council in June 2017, and which have continued to be considered as discussions have gone forward with various groups representing allied professions. The EO&AWP will meet one further time to wrap up any outstanding issues, after which it will wind up and the LWP will carry the work forward.

The Working Party is also keeping an eye on proposals for more structured post-graduate development and training coming from the RCVS Graduate Outcomes consultation, as there is likely to be overlap with its work.

In this meeting the Working Party reviewed a paper summarising the results a call for evidence that had been issued to stakeholders regarding veterinary nurses being able to act as prescribers. This had been sent to RCVS and VN Councils members, the BVA and its relevant specialist divisions including the British Veterinary Nursing Association (BVNA), British Small Animal Veterinary Association (BSAVA), British Equine Veterinary Association (BEVA), British Veterinary Zoological Society (BVZS), British Veterinary Hospital Association (BVHA), and the Society of Practising Veterinary Surgeons,as well as the British College of Veterinary Specialists (BCVSp) and the Major Employers Group (MEG).

Most of the individual responses were broadly supportive of the concept of VN prescribers, and there was a degree of consensus that this role could be responsible for prescribing some routine treatments such as worming and flea treatments, including prescription-only veterinary medicines (POM-Vs). There was, however, less consensus over the potential for veterinary nurses to carry out first vaccinations, and whether it was appropriate for a veterinary nurse to prescribe before a clinical assessment had been provided by a veterinary surgeon.

The Registrar also updated the Working Party on her discussions with other regulators about their disciplinary processes, and will continue to discuss her research on the different systems that are in place to see where improvements can be made.

During this meeting the Working Party agreed a working definition of the concept of the “veterinary-led team” and emphasised the importance of continuing to work closely with BVA on this concept.

The definition of the veterinary-led team, as defined by BVA, is as follows: “The veterinary-led team consists of appropriately-regulated professionals, including veterinary nurses, working under the direction of a veterinary surgeon, to protect animal health and welfare.”

The Working Party spent some time considering the model of regulation used by the General Dental Council (GDC). The GDC has a single umbrella term for all allied professionals (known as dental care professionals), and also has statutory powers to create new categories of dental care professionals that it can regulate.

Regarding the possibility of a veterinary nurse practitioner role, this meeting included a discussion about the difference between a ‘health check’ that might be carried out by a nurse practitioner and a ‘diagnosis’ which can only be carried out by a veterinary surgeon. The LWP also looked at the relevance of this concept to ongoing discussions around telemedicine. The Working Party agreed the importance of the principle of basing all arguments on animal welfare. The Working Party decided that a paper developing the risks and impacts of this proposal should be presented to the next meeting.

In considering reform to the disciplinary process, the Registrar noted that the RCVS is one of the only regulators (and the only healthcare-based regulator) still using the criminal standard of proof (‘beyond all reasonable doubt’) when determining the facts of a case. Most other regulators used the civil standard of proof (‘on the balance of probabilities’) when making their determinations. Consideration of moving to the civil standard has also been carried over from the College’s previous Strategic Plan and the Registrar agreed to review the last six months’ cases to assess what the likely outcome of those cases would have been under the civil standard, and the cost of change. The Working Party also decided to contact other regulators about their disciplinary processes, in order to gather information about their experiences of what does and does not work, both for long-standing issues and new reforms.

This meeting began by reviewing the work of both the VN Schedule 3 Working Party  (hyperlink) and the Exemption Orders and Associates Working Party (EO&AWP).

In order to provide structure to future meetings, the LWP agreed some key workstreams:

1. Exploring possible changes to Schedule 3 of the Act and the introduction of a veterinary equivalent of the NHS nurse practitioner role;
2. Reform of the RCVS disciplinary process;
3. Exploring the mandatory regulation of veterinary practices and consideration of how to bolster the regulation of the Practice Standards Scheme;
4. Consideration of compulsory continuing professional development (CPD) and limited licensure, depending on the recommendations made by the RCVS Graduate Outcomes Working Group;
5. Any other governance or related issues not discussed elsewhere.

At the inaugural meeting of the newly constituted Legislation Working Party (LWP), members considered a summary of previous reviews of veterinary legislation over the last 15 or so years. The Working Party also approved its Terms of Reference. Two of the College’s other Working Parties were also identified as feeding into the LWP in future. These were:

1. The Veterinary Nursing Schedule 3 Working Party
2. The Exemption Orders and Associates Working Party

It was confirmed that the LWP would consider any recommendations coming from those Working Parties to ensure that they were consistent with the College’s broader legislative reform agenda.

The LWP also recognised that its work includes some overlap with the Vet Futures project.

The LWP then spent the remainder of its first meeting identifying and collating outstanding issues with the 1966 Act of Veterinary Surgery (henceforth the Act). These include the possibility of a reform to the disciplinary process in line with other healthcare regulators, exploring the possibility of regulation the veterinary practice, as well as individual members of the profession, and giving consideration to the wider veterinary team by including, for example, the protection of the title of Veterinary Nurse in any future recommendations.

It was noted that the LWP would eventually need to consider whether its recommendations could be achieved without primary legislation, or whether a new Act would be required.

The LWP agreed that it would seek some meetings with other healthcare regulators, for example, the General Dental Council (GDC), to better understand how such organisations regulate their teams and to explore their disciplinary processes. The LWP also agreed to explore commissioning some research into varying business and practice models found in the veterinary industry.