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IS IT right that veterinary surgeons should be obliged to provide for emergency veterinary care for animals 24 hours a day, seven days a week, and, being realistic, can such an obligation actually be met?
This is not a new question, but it is one that continues to vex the profession, as evidenced most recently by an RCVS call for evidence on the subject, which was issued just before Christmas (see p 29 of this issue). This is not the first time the Royal College has looked seriously at the professional obligation to provide for 24-hour emergency cover: it conducted a lengthy review of its guidance on the issue between 2007 and 2009, having previously revised the guidance just a few years before (VR, April 14, 2007, vol 160, p 493). Then, as now, the requirement was causing problems in practice, not least because of concerns about the difficulties of reconciling it with the requirements of the UK's Working Time Regulations, but the general view at the time seemed to be that it should be retained. The question now is how much things might have changed.
The latest call for evidence is open to animal owners as well as vets and veterinary nurses. It seems partly to have been prompted by a recent disciplinary case involving a locum veterinary surgeon working in an out-of-hours clinic, which raised a number of issues relating to emergency treatment and stimulated much debate within the profession (VR, July 6, 2013, vol 173, p 6). It has also been prompted by comments from lay observers (and now lay members) on the College's Preliminary Investigation Committee who, over a number of years, have raised questions about the profession's ability to provide 24/7 cover to the extent required by the RCVS Code of Professional Conduct, and about an apparent mismatch between the public's expectations of 24/7 cover and the profession's capacity to meet them. In their latest report, the lay observers drew attention to the need for individual vets to meet their obligations under the code, while also drawing attention to the importance of owners, directors and leaders of companies and practices which provide 24-hour emergency care services ensuring that their protocols and businesses are code-compliant. They also commented: ‘If the profession is unable or unwilling to provide these services to the full extent required by the code, then the College must decide whether a less onerous provision should be introduced. As things stand, there is evidence of a disconnect between the public's expectations and the profession's capacity to meet those expectations.’
There is clearly much to consider in that statement, and many issues that need to be discussed. One of them is that there is a difference between taking steps to provide 24-hour emergency first aid and pain relief, which is what the code currently requires, and providing a full 24/7 service, albeit that, in the eyes of the public, the distinction can easily become blurred. It is also important to distinguish between a willingness to provide a service and what can realistically be achieved. In many respects, the range of services available through the veterinary profession, both in and out of hours, is remarkable. One only has to look at the apparent crisis facing accident and emergency departments in the (publicly funded) NHS to get an idea of the practical challenges involved.
There is no doubt that public expectations of the veterinary profession (as of so much else) have increased in recent years and it could be argued that, by constantly developing the range and level of services available, as it must surely continue to do, the profession has been complicit in that process. If expectations have been raised to unrealistic levels, then effort needs to be devoted to correcting that, perhaps by explaining some of the financial and other constraints on practices, which, unlike the NHS, are not state funded.
If public expectations cannot be managed effectively and the practical problems cannot be overcome then, as the RCVS's lay observers suggest, thought indeed needs to be given to making the current requirements less onerous. The question then is how this might affect the image of the profession and, more importantly, whether animal welfare would be compromised as a result. It will also be necessary to take account of the pressures that the current requirements impose on individual veterinary surgeons on a day-to-day basis, whether as veterinary employers or veterinary employees. There is much to discuss, and practitioners may have much to contribute, as the RCVS considers this issue in the weeks ahead.
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