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Seeking clarity on specialisation

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SOCIAL media seem not only to be affecting the way governments operate; they are also affecting the activities of the RCVS. The latest manifestation of this can be seen in the College's reaction to concerns expressed within the profession about a decision it made two years ago to remove the postgraduate postnominal letters attached to the names of vets listed in the RCVS Register. A petition protesting about the change, which was posted on the website www.change.org by veterinary surgeon Victoria Lilley a few weeks ago,1 has rapidly attracted nearly 1400 supporters, along with numerous comments expressing views on similar lines to those aired by Christopher Little in a letter in last week's Veterinary Record (VR, April 26, 2014, vol 174, p 433). Responding to the outcry last week, the RCVS said that it would be asking its Council to review the decision to remove the postnominals from the Register at its next meeting in June, to see whether the aims of the change could be achieved by better means (see p 437 of this issue).

The decision to remove the postnominals formed part of a much wider package of proposals on veterinary specialisation that was agreed by the RCVS Council in 2012 (VR, June 16, 2012, vol 170, p 606; July 14, 2012, vol 171, pp 39-41). The package had been developed by a working party chaired by Sir Kenneth Calman, a former Chief Medical Officer, which held a consultation exercise on its proposals as part of this process (VR, October 15, 2011, vol 169, p 398; February 11, 2012, vol 170, p 138). The working party was established by the RCVS in 2010, partly in response to a recommendation in the Lowe report of 2009. This memorably described the way veterinary specialisation was organised as ‘confusing and opaque’, suggesting that ‘the profession's concept of specialisation is inward-looking and orientated towards fellow professionals rather than aimed at informing the customer’. The Lowe report called for more clarity in the structure of veterinary specialisation, for vets as well as for members of the public, and one of the aims of the package of proposals agreed in 2012, including the proposal to simplify the way qualifications were listed in the RCVS Register, was to provide this.

Although the aim of the exercise might have been to simplify and clarify things, simplification can be a complex process, and change can be confusing in itself. This is particularly true as far as specialisation is concerned, as obtaining qualifications can be a lengthy process and it can take several years for changes in the system to work their way through. In addition, any new system must continue to give proper recognition to relevant qualifications obtained previously. Changes to the system of postgraduate specialisation have proved controversial in the past and, to that extent, it is not altogether surprising that elements of the substantial package of changes agreed two years ago should provoke controversy too. What, perhaps, is more surprising is that this particular aspect should only be exciting interest now.

The recommendation on postgraduate postnominals was just one of 26 made in the specialisation working party's report. Among others was that the RCVS should continue to publish and promote a list of recognised specialists, while also developing (in parallel with developments elsewhere in Europe) a list establishing a new ‘middle-tier’ of ‘advanced practitioners’ accredited at postgraduate certificate level. Only those on the specialist list would be able to describe themselves or be described by other veterinary surgeons as such when making referrals. The same would hold for advanced practitioners, and the aim would be both to encourage continuing professional development and to make clear to the profession and the public who was accredited by the RCVS at the relevant level. In addition, the working party recommended that the RCVS should actively promote its diploma of fellowship as the highest award issued by the College and develop new routes to the fellowship to make it more accessible to practising clinicians. The RCVS has since taken this and the other recommendations forward and is expected to consult on its fellowship proposals shortly (VR, March 22, 2014, vol 174, p 296).

At this stage, it is not clear how the RCVS Council will respond to the request to review the decision to remove postgraduate postnominal letters from the Register, although the College's Operational Board, and the response from the profession, seems to have given it a pretty strong steer. If clarity is the aim, one option, as suggested by the BVA during the original consultation exercise, would be to produce a generic guide explaining the existing levels of specialisation; this could be made available to the public and general practices to clarify the referral process and help clients understand the existing levels of expertise. While recognising scope for simplification and improvement, the BVA argued at the time of the consultation 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. Meanwhile, in revisiting the matter, the Council might want to consider whether removing postnominals from the Register actually improves clarity and the extent to which including them will affect the specialisation package as a whole. Debate around this issue may have been a long time coming, but it looks likely to continue for some time yet (see Letters, pp 456 and 457 of this issue).

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