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New structure for specialisation

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LAST October the RCVS issued a consultation document on proposals for simplifying and improving the system of veterinary specialisation, with a view to making it more understandable to the profession and the public (VR, October 15, 2011, vol 169, pp 398, 399). The proposals had been developed by an RCVS working party chaired by Sir Kenneth Calman, a former Chief Medical Officer, following a comment in the 2009 Lowe report that the current arrangements were ‘confusing and opaque’. Talk of changing veterinary postgraduate qualifications often excites interest, and this again proved to be the case. At the beginning of this year, the RCVS reported that the consultation had attracted nearly 300 responses, and that the working party was modifying its proposals in the light of the comments received (VR, February 11, 2012, vol 170, p 138). It has since done this and, at a meeting of the RCVS Council last week, its revised recommendations were approved. This means that they will now be taken forward.

This is not just an academic exercise, but one with very practical implications for vets, their clients and animal welfare. Altogether the working party's report makes 26 recommendations, covering, among other things, specialist qualifications, titles and designations, the creation of a new, recognised ‘middle tier’ of veterinary expertise, and the process of referral.

Regarding specialists, the Council has agreed that the RCVS should continue to publish and promote a list of veterinary specialists, which will include all those currently recognised as specialists by the RCVS or by a European specialty college. Entry to the list will require individuals to hold a postgraduate qualification at level 8 (doctorate level) in the National Qualifications Framework and/or to present evidence to a credentials committee that they have equivalent specialist experience and training. As now, continued inclusion on the list will require them to be revalidated at least every five years.

The Diploma of Fellowship will continue to be the highest award issued by the RCVS, and achieving the fellowship will continue to be one of the routes for achieving specialist status. However, it has also been agreed that those who have been on the list of specialists for a continuous period of 10 years should be awarded the title of RCVS Honorary Fellow in recognition of their longstanding commitment to their specialty.

For the new middle tier of expertise, the RCVS will set up a list of ‘advanced practitioners’. Entry to the list will require individuals to hold an appropriate qualification at postgraduate level 7 in the National Qualifications Framework in their subject/species areas (equivalent to level 11 in the Scottish Credit and Qualifications Framework). They will have to be practising in the named species/subject area and demonstrate a commitment to, and strong record of, continuing professional development. Like specialists, they will have to be revalidated at least every five years. ‘The section of the working party's report discussing the referral process will be important reading for practitioners, because it could potentially affect their approach’

On titles and designations, the Council has agreed that only those who are on the list of specialists should describe themselves as such, and that veterinary surgeons should not refer to another colleague as a specialist unless that colleague is on the specialist list. Similar considerations will apply to those on the list of advanced practitioners. It has also been agreed that the listing of postnominal letters for qualifications against members' names in the RCVS Register should be simplified to show only their registerable degree followed by either MRCVS or FRCVS and indicating whether the individual is on the specialist or advanced practitioner list (and indicating their species/subject area). Regarding the current Certificate in Advanced Veterinary Practice, it has been agreed that the RCVS should stop awarding additional species/subject designations with the certificates, but that holders of the certificate who have achieved a particular combination of modules and are admitted to the list of advanced practitioners will be able to show the species/subject area with the advanced practitioner title.

The section of the working party's report discussing the referral process will be important reading for practitioners, because it could potentially affect their approach. Also, how well things work in day-to-day practice will ultimately be a key measure of whether the new arrangements are successful. Among other things, it addresses concerns raised during the consultation process that the initial proposals were too restrictive in suggesting that ‘clients should have access to the highest level of expertise in every case’. In the report approved by the Council, the working party makes clear that ‘it was not its intention to suggest that every case should be referred to a specialist, nor that the role of the general practitioner should be diminished, nor that certificate holders are not doing excellent work and should not take referrals’. It says the principle it was trying to get across is better expressed as ‘clients being made aware and having access to the most appropriate expertise that is available for each case’. It acknowledges that there are many shades of complexity involved in the referral process and recognises the role of professional judgement in deciding who to refer to and when, while also emphasising the importance of informed client consent when making referrals.

The report makes some useful recommendations regarding promotion and publicity, including a recommendation that the RCVS should produce simple leaflets or posters explaining the various levels of veterinary qualification and factors to be taken into account when considering a referral, which practices could make available to clients. Such information could help resolve some of the confusion that surrounds the current arrangements as well as the confusion that might ensue as the new arrangements are introduced.

Simplification is a complex process and the working party acknowledges that some of its recommendations require further development. Also, because obtaining qualifications is a lengthy undertaking, some of its recommendations will take time to work through. Nevertheless, the RCVS Council's approval of the document is a significant development that will clearly affect the way the profession and veterinary practice develops in the future.

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