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Remote prescribing by vets to continue
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By Josh Loeb

Vets can continue prescribing prescription-only veterinary medicines (POM-Vs) remotely without first physically examining the animal – but must have arrangements in place to provide back-up care.

That was the decision of RCVS council on 8 October, following a heated debate on the issue.

Council members also voted to impose new checks and balances on an RCVS Covid-19 taskforce, a small group set up to take decisions quickly instead of waiting for committee or council decisions.

The developments followed mounting unease after temporary remote prescribing was first introduced by the Covid-19 taskforce in March. The provision was originally set to run until June, but it has been extended multiple times (see chronology, below).

Critics feared the door was being left ajar for vets to prescribe POM-Vs from afar without offering 24-hour back-up care.

Last week, the BVA also weighed in, querying why a measure brought in as a time-limited response to the first wave of Covid-19 had been rolled over time and again (see https://bit.ly/33R1rcb).

The issue came to a head at the latest council meeting, when a gang of five council members– Jo Dyer, Neil Smith, Danny Chambers, Martin Peaty and Richard Stephenson – pressed for guidance to be amended to state that all remote prescribers should offer back-up care.

Dyer and Smith proposed a motion stating that remote prescribing ‘should only be carried out by veterinary surgeons who can provide [an out-of-hours] follow-up service involving physical examination, plus or minus further investigation, if required’.

Such a follow-up service ‘can be provided personally by the veterinary surgeon or practice, or by written agreement with a veterinary services provider which is local to the client (as with the current situation for [out-of-hours] care provision)’.

Debate was impassioned, with council members voicing disagreement about the best way forward against the backdrop of increasing Covid-19 cases and the reimposition of various restrictions in the worst-affected UK regions.

We’re right inside the pandemic, and the light at the end of the tunnel is not yet even a flicker

‘We’re right inside the pandemic, and the light at the end of the tunnel is not yet even a flicker,’ RCVS senior vice president Niall Connell warned, adding that ‘the “new normal” isn’t strictly a new normal, it’s a new normal of dynamic normals’.

He urged colleagues to ‘consider the support temporary remote prescribing can provide in so many circumstances – to sick animals, to the vulnerable and to beleaguered practices’.

Remote prescribing without prior physical examination should continue ‘at least into the new year’, Connell urged.

His sentiments were echoed by the college’s junior vice president, David Argyle, who said an ‘armoury’ of measures was needed to support colleagues and animals.

But Stephenson, who backed the motion, insisted no-one was proposing that remote prescribing be scrapped, merely that safeguards be created.

Chambers acknowledged remote prescribing had become an ‘emotive’ issue. As a result, he said, ‘the last couple of council meetings have been a bit strained’.

He added: ‘I’m sure it’s completely inadvertent, but I do feel a little bit frustrated that many of us who are first-opinion vets, who’ve expressed concerns regarding the direction of remote prescribing and how we manage it, we’ve been made to feel as if we’ve been kind of troublemakers with fringe views.

‘The reality is, we’re really expressing the same views as those of the BVA and British Equine Veterinary Association. They’re views shared by much of the profession.’

Chronology

24 March – RCVS Covid-19 taskforce temporarily permits vets to prescribe POM-Vs remotely.

25 June – Taskforce extends remote prescribing for the first time.

6 August – Taskforce extends remote prescribing for the second time.

3 September – Some council members query the taskforce and extensions.

21 September – ‘Short notice’ council meeting held in private (see p 291).

30 September – RCVS announces third extension of remote prescribing – until the end of October – but with the additional requirement for the prescribing vet to consider whether the animal can first be brought under their care.

8 October – RCVS council votes in favour of amending guidance to require back-up 24-hour provision of care and for greater oversight of the taskforce.

However, he said it was reassuring that the issue was being debated openly and constructively, adding that the taskforce had done good work.

Dyer also praised the taskforce’s work but told fellow council members: ‘Let’s be crystal clear about what we’re deciding here. If we vote against [the motion], we have decided that an animal can be “under care” with no ongoing responsibility for that animal’s welfare.

‘The diagnosis might be incorrect. The POM-V may, therefore, be useless, or may even make matters worse. And the prescribing vet will be under no obligation to continue the job they have started. That would be a retrograde step for animal welfare.’

Council voted by a large majority – 21 to two, with two abstentions – for the motion to amend the guidance.

A related motion for greater oversight of the emergency RCVS Covid-19 taskforce was also carried – by a majority of 15 to eight, and one abstention.

As a consequence, the taskforce will now become a standing item on the agenda of the RCVS council.

Smith said the move was not about ‘micromanaging’ the taskforce. ‘We had to fight to get this discussion in council...and we want to make sure that it is a fight we don’t have to have in the future,’ he added.

In relation to temporary remote prescribing, he commented: ‘Temporary is a difficult word. I know from my previous work on another committee that there was a person who had “temporary” [veterinary] registration with the RCVS for several decades...so it’s important that these things are time limited, even if that time limitation is just by review.’ ●

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