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New guidance on 24-hour cover

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FEW issues have generated as much interest in the profession over the past 12 months as a review of the obligation on practitioners, set out in the RCVS Code of Professional Conduct, to provide for 24-hour emergency cover. A call for evidence on the subject, issued by the RCVS towards the end of last year, elicited more than 300 responses, highlighting some of the practical, ethical and financial issues involved. Meanwhile, an online petition on the related topic of house visits, launched independently by veterinary surgeon Joanna Dyer, quickly gathered more than 2700 signatures (VR, March 29, 2014, vol 174, p 310).

The review and the petition were prompted partly by the outcome of a disciplinary case involving Munhuwepasi Chikosi, who was struck off the RCVS Register last year for failing to attend promptly to an injured dog (VR, July 6, 2013, vol 173, p 6), and partly because of concerns about a mismatch between the public's expectations of 24-hour emergency care and what can realistically be provided. Following a detailed and particularly thorough review by its Standards Committee, and as agreed by its Council in June (VR, June 14, 2014, vol 174, pp 592, 593-594), the RCVS has now revised its guidance on 24/7 emergency cover, in an attempt to address the concerns that have been raised.

In line with views expressed during the College's evidence-gathering exercise, the obligation on veterinary surgeons to take steps to provide for 24-hour emergency first aid and pain relief for animals has been retained. However, two sections of the supporting guidance to the Code of Professional Conduct – on ‘Veterinary care’1 and on ‘24-hour emergency first aid and pain relief’2 – have been updated and expanded to place greater emphasis on the legal responsibilities of owners for their animals, while also placing an obligation on veterinary surgeons to provide full details of the out-of-hours service they provide. Where emergency provision is outsourced, practices will be expected to ensure that their clients are given full information about the service.

The revised guidance also seeks to clarify situations where declining or delaying attendance to an animal may be appropriate, making clear, for example, that ‘In all but exceptional circumstances, the interests of companion animals will be best served by being taken to a veterinary practice, where the attending veterinary surgeon has access to a full range of equipment, veterinary medicines and appropriate facilities.’ Exceptional circumstances, it suggests, might include an entrapped animal that cannot be moved before receiving veterinary attention.

It also aims to help and empower vets to decline to attend an animal away from the practice when they feel this is unnecessary or unsafe. It states, for example, that, after considering all the relevant factors, ‘Veterinary surgeons are not obliged to attend away from the practice, unless in their professional judgement it is appropriate to do so’ and also that vets are ‘entitled to decline a visit where they have overriding personal safety concerns’. At the same time, veterinary surgeons who decline a visit are advised to inform the owner or person making the request and to document any advice given and the reasons for their decision, in case of future challenge. The guidance makes clear that RCVS disciplinary action in relation to refusal to attend away from the practice will be considered where there has been ‘a wilful disregard for animal welfare’.

Other matters considered by the guidance include dealing with requests from non-clients, provision of 24-hour emergency cover in remote regions, and what is expected in terms of 24-hour cover from limited service providers and referral practices. Continuity of care and the possible transfer of animals between practices or premises is considered in the section on veterinary care, which, among other things, states that ‘A veterinary surgeon should not carry out elective surgery in the knowledge that the animal will require significant and immediate aftercare which cannot be provided in-house.’ Instead, it says, arrangements should be made for the procedure to be carried out at another practice or premises where appropriate aftercare can be provided without the need for the animal to be transferred in the immediate postoperative period.

Regarding costs, the section on 24-hour emergency first aid and pain relief notes that out-of-hours services are generally more expensive to provide and that, as a result, clients might be required to pay an additional premium for emergency veterinary attention outside normal working hours, and that vets might charge higher fees for unregistered clients. It states that likely costs and arrangements should be discussed at an early stage, but that immediate first aid and pain relief should not be delayed while financial arrangements are agreed.

On publishing the new guidance this week, the RCVS said that, by making the responsibilities of owners and veterinary surgeons clearer, it hoped to ‘allay some of the frustrations and concerns of the profession’. There is no doubt that confusion about how the obligation should be interpreted has caused much anxiety in the profession over the past 12 months and this, along with some of the practical issues associated with providing 24-hour cover, is well documented in a report by the RCVS Standards Committee considered by the RCVS Council at its meeting in June.3 In revising the guidance, the Standards Committee faced a difficult task, not only in trying to balance what might be desirable with what is achievable, but also in coming up with advice that leaves room for professional judgement and is sufficiently flexible to take account of the different circumstances and types of practice, and the many different situations that can arise. Given the nature of the challenge, the outcome is unlikely to satisfy everyone, but no one could argue that the committee was not assiduous in its approach to the review, which also took the views of animal owners into account.

This is not the first time the College has looked at the obligation to provide 24-hour cover in recent years (it last reviewed the situation in 2009) nor, given that society and practice continue to evolve, is it likely to be the last. Ultimately, the success of the new guidance will depend on how well it works in practical terms in helping to ensure that animal welfare continues to be protected. The service provided by practitioners is remarkable, particularly when one considers that, unlike the situation in the NHS, there is no state funding to support it.

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