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Simplifying specialisation

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SIMPLIFICATION can be a complex process. Last October, an RCVS working party, chaired by Kenneth Calman, a former Chief Medical Officer, issued a consultation document setting out its thoughts on how the system of veterinary specialisation might be simplified and improved to make it more understandable to the profession and the public (VR, October 15, 2011, vol 169, pp 398, 399). Talk of changing veterinary specialist qualifications has proved controversial in the past and this again seems to have been the case. A recent progress report on the RCVS website notes that the consultation generated 290 responses, expressing ‘a wide range of views’.1 The working party is now revising its proposals in the light of the responses, for consideration by the RCVS Council later this year. In the meantime, the progress report sets out its position on some of the issues raised.

One of the more controversial proposals in the consultation document was a suggestion that, as an underlying principle, ‘clients should have access to the highest level of expertise for every case’. This was of concern to a number of those responding to the consultation (including the BVA), not least because many factors need to be considered when referring cases, such as the owners' ability to afford specialist treatment for their animal or to travel long distances to obtain it. In the progress report, the working party states 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 veterinary surgeon should be diminished, nor that certificate holders aren't doing excellent work and should not take referrals’. The principle, it says, would be better expressed as ‘clients having access to the most appropriate expertise that is available for each case’.

Another concern was that the consultation document placed too much emphasis on the findings of the 2009 Lowe report. This had criticised the arrangements for specialisation specifically in the context of production animal practice, describing them as ‘confusing and opaque’, whereas the consultation document had considered specialisation across the profession as a whole. On this, the progress report states that Professor Lowe's findings were not the main impetus for establishing the working party but were ‘coincidental to RCVS becoming aware of the growing complexity of the landscape’. The working party still firmly believes that specialisation was in need of review and that there is scope for clarification and improvement.

It is not mentioned in the progress report but, if confusion is a problem, one suggestion, put forward in the BVA's response to the consultation,2 would be to produce a generic consumer guide explaining the existing levels of specialisation. Such a guide could be made available to the public via general practice to clarify the referral process and help clients understand the different levels of expertise. While recognising that there is scope for simplification and improvement, the BVA contends that the current system of specialisation is well understood by the profession and that, so long as the referring vet knows how to navigate what is available and communicate this effectively to clients, the system works well. It sees strength in the flexibility of the current system and is anxious to ensure that this is not lost.

The progress report notes that there was general support for the working party's proposal for a ‘middle tier’ of veterinary surgeons who would be subject to periodic reaccreditation, as well as for simplification of qualification titles and postnominal letters, but acknowledges that more discussion is needed on the descriptors used to indicate areas of expertise. Opinion on whether veterinary surgeons who are accredited as specialists should also be entitled to be called Fellows of the Royal College was divided, with strong opinions being expressed on both sides. On the question of increasing the number of specialists, the working party wants to explore further the notion of alternative routes to specialist status, particularly in view of the feedback received about the difficulties of pursuing a diploma qualification while working in practice.

All in all, the report gives the impression that there is still much to discuss regarding specialisation and that this is not an issue that can be settled overnight. ‘There will no doubt need to be further iterations of ideas,’ it says, adding that it would be better to produce the right proposals rather than to rush things through. Such an approach seems eminently sensible, not least because change can be confusing in itself and because obtaining qualifications is a lengthy process and it can be many years before the impact of any decisions is felt.

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