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IT IS too early to say how many people will respond directly to the RCVS's recent call for evidence on the requirement on vets to make provision for 24-hour emergency cover (VR, January 11, 2014, vol 174, p 28), or what the eventual outcome will be, because the consultation doesn't close until February 17. However, it is hard to believe that the College's consultation will attract as many responses as have been generated by an online petition at www.change.org on the related subject of house visits. The petition has been started by veterinary surgeon Joanna Dyer and calls for the ‘mandatory’ requirement on vets to make house visits to be removed from the Code of Professional Conduct.'1 So far, this has gathered more than 2000 signatories. It may well be, as the RCVS President, Neil Smith, pointed out in a statement posted on the RCVS website last week,2 that the petition is ‘working on a misunderstanding’ and that veterinary surgeons ‘are not mandated to attend away from the practice just because an owner has requested a visit’. Nevertheless, perceptions are important and, as Colonel Smith also points out in his statement, if the RCVS guidance is so widely misunderstood, and so many veterinary surgeons mistakenly believe that house visits are mandatory in all instances, then something has to be done about it.
The petition, like the RCVS consultation, has in part been prompted by the outcome of an RCVS Disciplinary Committee hearing involving Munhuwepasi Chikosi, who was struck off the RCVS Register last year for failing promptly to attend an injured dog while working as a locum in an out-of-hours clinic (VR, July 6, 2013, vol 173, p 6), and both the petition and the RCVS President's statement refer to that case. The petition points out that the outcome of this and previous disciplinary cases have caused stress and anxiety among veterinary professionals, particularly among younger and less experienced vets, many of whom now feel unable to refuse house visits. It argues that the welfare of other small animal patients may be compromised when a vet is out on a house call, and also suggests that ‘It is only a matter of time before a vet is assaulted whilst carrying out a house visit.’
The relevant section of the RCVS guidance states: ‘Clients may request attendance on a sick or injured animal away from the practice premises and, in some circumstances, it may be desirable to do so. On rare occasions, it may be necessary on clinical or welfare grounds. The decision to attend away from the practice is for the veterinary surgeon, having carefully balanced the needs of the animal against the safety implications of making the visit; a veterinary surgeon is not expected to risk “life or limb”, or that of anyone else, to provide the service.’
Colonel Smith acknowledges that recent disciplinary cases, especially the one involving Mr Chikosi, have increased concerns in the profession that vets will be disciplined for not turning out to every request for a home visit, but, he says, ‘This is not the case.’ He explains that, for someone to be taken to a disciplinary hearing for refusing to attend an animal away from the practice, first a complaint would have to be made and then the RCVS's Preliminary Investigation Committee would have to be convinced that the vet could not justify the decision not to attend the animal. Such cases, he says, are rare: only 3 per cent of the complaints received by the College last year were about 24-hour veterinary cover, and not all of these related to home visits.
For all that, the potential disciplinary consequences of not undertaking a home visit are clearly causing anxiety in practice, and many of the comments that have been posted online by those supporting Ms Dyer's petition attest to this. Meanwhile, it would be wrong for anyone to ignore the risks associated with house visits, and this is an issue for employers as well as employees. The RCVS guidance talks of not risking ‘life or limb’, but maybe this could be expressed more sympathetically. The BVA has produced guidance for its members on this issue, which is available at www.bva.co.uk/members/documents/domiciliary-visits-and-lone-working-2013.pdf. An article on personal safety in veterinary practice, by Rachel Griffin of the Suzy Lamplugh Trust, was published in In Practice last year, and may also be helpful in this context (In Practice, May 2013, vol 35, pp 279-281).
Colonel Smith says that the comments from the signatories to the petition will be fed into the RCVS's 24-hour emergency cover review and that, if so many vets believe that house visits are mandatory in all circumstances, the wording of its guidance needs to be reviewed ‘at the very least’. That in itself is welcome and it will be interesting to see how the matter is addressed. In the meantime, however, the debate around this issue raises another question: if the guidance on house visits is widely misunderstood, as appears to be the case, how many other aspects of the RCVS's guidance might be being misconstrued, and how much unnecessary anxiety might be being generated as a result? Work-related stress is no small matter for the veterinary profession, as an article by Michael Meehan on p 142 of this issue of Veterinary Record explains.
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