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Is “hands-on” care a thing of the past?

The changing definition of “in our care” was discussed in the BVA Congress at London Vet Show on 16 November

27 December 2018, at 10:24a.m.

Rapid technological advances and the pressure on vets to delegate some of their traditional responsibilities to other professional groups are changing the meaning of the term “under our care”. But how can veterinary organisations direct the pace and direction of this process to ensure that practitioners are able to keep their promise to safeguard the welfare of their clients’ animals?

A changing profession

Practitioner and BVA past president Robin Hargreaves chaired the committee set up to investigate these issues. He told colleagues that a complex task was made more difficult by the lack of a legal definition of what is meant by “under our care” in the 1966 Veterinary Surgeons Act.

At that time, legislators would have understood this to mean any patient being assessed and treated by a veterinary practitioner. But there are now many other groups – such as hydrotherapists and nutritionists – responsible for aspects of the animal’s welfare. Meanwhile, the growth in monitoring technologies and the intensification of livestock systems means that vets no longer provide hands-on care for their clients’ animals. There is also a growing public scepticism about professional expertise, which has encouraged some to seek advice from other sources, he said.

The veterinary profession is not alone in facing pressure to change. Only a few days earlier, the Royal College of Physicians (RCP) had issued a statement claiming that the concept of delivering medical services through face-to-face consultations was rooted in the 18th century. The RCP insisted that it was not just desirable but essential for human doctors to develop more cost-effective methods.

However, “while the NHS and the veterinary profession may be working towards a similar model... we are doing it for different reasons. They are trying to save money while we are trying to achieve better animal welfare outcomes – it is critically important that this remains the driver,” he said.

The BVA committee has been exploring options for creating a vet-led team of associated professionals. The core principles must involve the vet’s right to diagnose, the integrity of the veterinary signature and the establishment of clear lines of responsibility between the vet and those other professionals, Robin said.

He said the Veterinary Defence Society has highlighted a potential hazard when the vet provides a referral form for the patient to be seen by a non-veterinary professional. Such forms are intended to confirm that the animal is fit to undergo an intervention such as hydrotherapy – it is not an endorsement of the treatment. There is a risk that the practitioner may be in a position of “vicarious liability” if the treatment goes wrong. “If you are the better insured party then you are the one that the client will go after,” he said.

Nevertheless, the current shortage of veterinary manpower means there is a need to relinquish certain tasks. The emergence of RVNs as an associated profession was a model for how other professional groups could be absorbed into the veterinary team. But there are still some unresolved issues in making best use of the nurse’s skillset. Robin cited the lack of understanding of tasks that may be delegated under schedule 3 of the Act as a stumbling block.

Using technology to improve care

Meanwhile, the developments in health monitoring technologies would have a huge impact on practice and open up fresh opportunities for providing clinical services, according to Anthony Roberts, director of leadership and innovation at the RCVS. He said that interpreting the data produced by wearable monitoring devices gave vets scope to engage with their clients and the RCVS was examining the responsibilities of its members in this area.

Robin agreed that telemedicine will provide opportunities for improving the health of many animals but would be unlikely to help reach those that are never seen by a vet. Many clients were unlikely to be influenced by the opportunities for an online consultation. He advised caution in changing the rules on providing long distance care. “The people who develop these technologies move very quickly but that doesn’t mean we have to as well – we have to be careful that we create a suitable regulatory structure.”

Anna Judson, a practitioner from mid-Wales and member of the SPVS board, argued that research was needed on matters such as the frequency that hands-on examinations reveal health problems unrelated to the reason for the original veterinary consultation.

There were also dangers in allowing other professions to take responsibility for any follow-up care as this would likely affect the economics of practices and their ability to maintain current services. Moreover, some clients may already have to travel long distances to access veterinary care. “If that care is no longer there, animals will die and so we must be wary of potential trade-offs when using technology to improve some aspects of animal welfare; it may cause a worsening of others. We must be aware of the law of unintended consequences.”