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Realities of 24-hour cover

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IT IS, perhaps, a measure of how quickly things continue to change in veterinary practice that, although it is only two years since the rcvs revised its guidance on the provision of 24-hour emergency cover, it is revisiting the issue — specifically, with a view to providing additional guidance on the provision of cover in remote regions. It is currently seeking comments from practitioners on the realities of providing 24-hour cover in remote parts of the uk and on proposed additional guidance (VR, March 24, 2007, vol 160, p 386). In a presentation to the bva's Council last month, Dr Jerry Davies, chairman of the College's 24-hour emergency cover working party, outlined the thinking behind the initiative and sought to clarify the College's approach to the issue of out-of-hours cover generally (VR, April 7, 2007, vol 160, p 457).

Current rcvs guidance states that veterinary surgeons in practice should ‘take steps to provide 24-hour emergency cover for the care of animals of those species treated by the practice during normal working hours’, and that, when on duty providing 24-hour cover, they should ‘not unreasonably refuse to provide first aid and pain relief for any animal of a species treated by the practice during normal working hours’. It further states that they should ‘not unreasonably refuse to provide first aid and pain relief for all other species until such time as a more appropriate veterinary service accepts responsibility for the animal’ and that they should ‘not unreasonably refuse to accept responsibility for an animal from a colleague, in order to provide first aid and pain relief for that animal’.

The current guidance differs from that in place previously, when practitioners were obliged to make provision for emergency cover for all species. Encouraging a collective approach, it reflects increased specialisation in practice while seeking to ensure that appropriate emergency treatment continues to be available from the profession as a whole. However, while the growth of small animal emergency clinics and increased sharing of out-of-hours arrangements may have helped in the provision of emergency cover in some areas, they are not an option where practices are thin on the ground and where emergency treatment is becoming, if anything, increasingly difficult to provide. The rcvs recognises that there may be insufficient veterinary ‘manpower’ in remote regions to enable the veterinary surgeons concerned to comply with the guidance and its current guidance states: ‘In isolated ommunities, there may be a need for a pragmatic approach to the provision of 24-hour emergency cover, provided that clients and the nearest veterinary practices are fully informed of the arrangements.’ Its aim in providing additional advice would be to help veterinary surgeons in remote regions develop such an approach.

Other matters being looked at by the working party include the provision of emergency cover by referral practices, and the implications for practices of the European Working Time Directive, particularly in view of last year's decision by the European Court that the uk's interpretation of the directive was incompatible with its objective (VR, September 23, 2006, vol 159, pp 401-402). With regard to referral practices, it is examining whether current advice needs to be strengthened, to take account of cases not already being seen by the practice. On the matter of the Working Time Directive, it is looking to provide some general advice on what flexibility exists under the regulations and possible changes in the future.

Dr Davies made clear in his presentation that in this, as in other areas, the rcvs could not provide advice that was specific to all circumstances; it could not give specific advice about employment and business matters, and practices should seek their own legal advice where necessary. Unfortunately, some of the answers would depend on case law, which in this instance had still to be established. The Department of Trade and Industry had indicated that it would fight to retain the uk's opt-out from the 48-hour working week but, in the meantime, the rcvs working party took the view that there was sufficient flexibility in the working time regulations for veterinary employers to comply with them. The number of veterinary surgeons working more than 48 hours a week was falling, and Dr Davies expressed the hope that the profession would be moving towards trying to have people working no more than 48 hours if possible.

Dr Davies ended his presentation by noting that the standards the profession sets itself influence its standing in the eyes of the public, and that lowering those standards could damage the profession's reputation and potentially, therefore, veterinary surgeons' livelihoods. This sentiment seemed to be shared by bva Council members, with more than one member remarking that the out-of-hours service provided by the profession should not be ‘dumbed down’. That said, the self-imposed requirement to provide 24-hour cover continues to present challenges for the profession, which continue to change in the light of changes in animal demographics, public expectations and in the profession itself, as well as changes in employment law and the economics of practice. The rcvs must continue to examine its guidance in the light of developments and, in doing so, maintain a pragmatic approach. The College cannot by itself resolve the problems being encountered in ensuring a meaningful veterinary presence in remote areas of the country, but the aim of its advice should be to contribute to solutions, rather than add to the difficulties.

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