Should the veterinary profession not be honest about its willingness to provide domiciliary visits to treat animals at the homes of its small animal clients?
This was the question raised by Dr Bradley Viner, who practises in north London, at the March meeting of the RCVS Council. He believed it was time to remove the threat of disciplinary action against veterinary surgeons who were unable to provide such a service.
Home visits have long been seen by many practitioners both as an inefficient use of professional time and clinically unsatisfactory, because it is more difficult to provide the highest standards of care without the facilities available at the practice premises.
The RCVS Guide to Professional Conduct, however, warns that attendance away from the practice premises may be necessary in some cases and in July 2007, a Somersetbased practitioner, William Baird, was struck off the register for refusing to attend to a dog which had collapsed at home.
The RCVS advisory committee has been considering possible changes to the Guide as part of a broader debate about the provision of 24-hour emergency care. The latest draft states that the decision on whether or not to attend rests entirely with the veterinarian concerned.
It says the veterinary surgeon should consider a range of factors including the location and state of the animal, the likely treatment needed, the possibility of the animal being safely conveyed to the surgery, and so on.
In a debate at the Council meeting, Dr Viner insisted that the current advice in the code was a “fudge” – and the proposed changes would fudge the issue even more.
“If a practice says that it doesn’t make home visits, then it risks having the wrath of the Royal College fall upon it. But for others, the proposed changes give them all the excuses needed to justify not making home visits.
“Isn’t it time to be honest in saying that the veterinary practice has an obligation only to make clear in advance what its policy is on home visits? The onus is then on the animal owner to make arrangements suited to his or her needs,” Dr Viner said.
Two non-veterinary members of the Council were concerned about the advice being offered by the advisory committee on the criteria for assessing whether a home visit might be appropriate.
Privy Council appointee Barbara Saunders noted that these addressed issues relating to the animal and the attending veterinary surgeon but not the pet-owning client.
Disciplinary Committee member Alison Bruce said her colleagues would be anxious to know about the physical condition of the client in any case in which there had been a categorical refusal to attend.
Bob Partridge, who runs a veterinary hospital in Harrogate, felt that physical infirmity was not the main reason for clients demanding a home visit. It was much more common for them to explain that they were too drunk to drive to the surgery or that they had insufficient money for a taxi.
Mark Elliott, who practises in Suffolk, agreed with this claim, insisting that there should be greater consideration of the requirements of the Animal Welfare Act and its warning that pet owners have a responsibility to ensure that they are able to access appropriate veterinary care for their animals: “It is not up to us to cover every eventuality.”
Reasonable grounds
Mrs Bruce rejected the suggestion that practitioners would find themselves in trouble with the Royal College for refusing to attend to a client who was drunk. She pointed out that the Preliminary Investigation Committee has an obligation to consider whether there were reasonable grounds for complaint and would only take action on those claims in which there had not been proper consideration of the client’s needs.
Lynne Hill, a former president, agreed, stating that the specific circumstances would be assessed in any decision by the PI Committee, which would want to know about issues such as the availability of pet ambulance services in the area or of taxi firms that were willing to transport a pet animal.
Richard Stephenson, who practises in Staffordshire, queried why this issue was being debated by the Council at this stage when it was intended to provide time for debate on the domiciliary visits and emergency cover issues at the June meeting. The president, Jill Nute, then asked members to provide comments on the advisory committee proposals in time for that meeting.
In further discussion of the advisory committee report, Mr Viner also complained about the Royal College agreeing to co-operate with the Veterinary Medicines Directorate in providing an inspection service to help implement regulations on the registration of premises used for dispensing veterinary medicines.
Beyond requirements
He insisted that the VMD’s regulations went beyond the requirements of the EU directive that they are intended to implement. He argued that the Royal College’s role in the inspection process, set out in a memorandum of understanding between the two organisations, went beyond the level of participation agreed in Council.
“Our job is to treat poodles, not to act as one,” he said.
But Dr Viner failed to secure the support of a majority of Council members for his proposal to reject the memorandum of understanding. The chief veterinary officer at DEFRA, Nigel Gibbens, believed the inspection system was proportionate to the needs of regulations which were drawn up to protect human health.
He said that according to the Government’s policy, regulations had to take account of the degree of risk involved and initially, at least, inspections would be necessary to assess those risks, he said.
The assistant registrar, Gordon Hockey, noted that some form of inspection was compulsory for all veterinary premises. But carrying out that inspection as part of the process for participating in the RCVS’ entirely voluntary practice standards scheme was a useful way of avoiding duplication and would benefit the practices concerned.
Lynne Hill agreed that a process of voluntary registration with no compulsory inspection system would not satisfy the general public that the profession was continuing to meet acceptable standards.
