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Should prescribing changes be kept?

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By Josh Loeb

The chief executive of the RCVS has spoken about being ‘under pressure from both sides’ over remote prescribing.

Lizzie Lockett (pictured) said some stakeholders were clamouring for pandemic-related changes to be made permanent, while others lobbied for a return to the status quo ante.

She said the profession had to ask itself what was best for animal health and welfare, in addition to questions about accessibility of care and public health, when weighing up whether to retain changes to allow a greater degree of telemedicine in the UK.

‘We’ve heard this phrase “we’ve kind of let the genie out of the bottle” or “we’ve opened Pandora’s box” on remote prescribing and can we go back? I suppose the first question has to be, do we want to [go back]?’ she said.

While the college ‘shouldn’t be afraid to go back [to the previous state of affairs] if that’s genuinely the right thing to do’, she said it should come to a considered judgement.

Change may have been quick but reflection should be measured

Speaking during a panel discussion about regulators’ views on the use of telemedicine – part of the Digital Veterinary Summit, held on 25 August – Lockett added: ‘Change may have been quick but reflection should be measured.’

Her comments come after the RCVS extended its temporary guidance allowing vets to prescribe prescription-only veterinary medicines remotely up to 30 September.

Vets have been allowed to prescribe for animals without first carrying out a physical examination since 24 March. The change was introduced in response to the public health and animal welfare emergency brought about by Covid-19 and the UK having gone into nationwide lockdown on 23 March.

‘We’ve been, as a regulator, much less risk averse,’ said Lockett. ‘There’s nothing like a public health crisis – and sadly people dying – to put things into perspective. Public health has had to come to the fore.’

Now, however, some tech innovators – who stand to benefit if the changes are made permanent – are calling for no return to the previous state of affairs, whereby remote prescribing was not permitted under the RCVS Code of Professional Conduct or supporting guidance.

‘In the UK we’re under pressure from both sides on this,’ Lockett explained. ‘Just yesterday there was a headline in one of the UK publications saying “Ending remote prescriptions is ‘foolish,’ RCVS warned”, which is a story generated, unsurprisingly, by the founder of one of the remote veterinary apps.

‘Equally, I’m lobbied on a daily basis by those who want to return to the [previous] status quo as soon as possible. They believe that remote prescribing is inefficient, inaccurate and risky. So we’re trying to sort of sit in the middle and balance these two things.’

Lockett stressed that the decision to permit remote prescribing temporarily had been taken to ameliorate the ‘difficult circumstances’ engendered by the pandemic and lockdown and was not influenced by any other factors.

‘We’ve found it’s allowed practices to continue to work safely and provide access to veterinary services,’ she also said. ‘It means individuals in the practice team who may be shielding can continue to contribute meaningfully and that animal owners who may be unwilling or unable to travel have been able to access veterinary care. So from an animal welfare perspective it’s been positive.’

• If vets don’t focus on adding value and offering ‘multimodality care’ – including the use of internet-based communication, phone, video, chat and texting – clients could look elsewhere for veterinary care services, experts warned. See full story online at 10.1136/vr.m3414

Accessibility versus regulation

Also on the panel for the discussion of regulators’ views on telemedicine were Jan Robinson, chief executive of the College of Veterinarians of Ontario in Canada, and Jim Penrod, executive director of the American Association of Veterinary State Boards, a USA-wide regulators’ association.

Robinson discussed how necessity had been the mother of invention during the pandemic. She said: ‘I think we would all agree that this pandemic has been a great nudge in terms of some of the uptake and, at the very least, the discussion related to virtual care.’

Penrod, meanwhile, talked about how in the USA there was a perceived clash between accessibility of care and regulation. The latter, he said, was also seen by some as stifling innovation.

‘One outside group that is sort of anti-regulation suggests that we should just get rid of [veterinary] licensure in the USA and create a system like Amazon with clients – the public – giving stars to their veterinarian. So, you know, is this a ‘five star’ veterinarian or a ‘one star’ veterinarian, and so on,’ he said.

‘As a regulator one of the challenges is that you truly want to protect the public and you see some systems where they get people from the outside that take advantage and post fake things – that kind of thing. It’s always been a challenge to balance access to care with this idea that we protect the public and animals.’

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