In 2018 the APHA conducted a public consultation on the proposal to extend the use of Approved Tuberculin Testers (ATTs) into private veterinary businesses in England to carry out TB skin testing of cattle. Responses to the consultation were generally positive, the key points raised being the need for robust veterinary supervision and quality assurance (QA).
APHA conducted a pilot to test the proposal and to ensure that the points raised in the consultation were rigorously examined. A total of 19 veterinary practices across four of the five English Veterinary Delivery Partner (VDP) regions took part and 22 ATTs were recruited.
The pilot’s objectives were to test the methods and procedures concerned with the use of ATTs by private veterinary businesses including registration, theoretical and practical training, supervision, authorisation, performance and QA. Criteria were set against which the objectives were measured.
The pilot was very successful. The majority of the delivery criteria were met and the few issues which arose have been resolved and action taken to reduce future risk of recurrence. Many of the issues raised are not ATT specific and highlight issues common to any TB tester. The issues, along with extensive feedback received during the pilot, have been fundamental in informing improvements to the processes and highlighted areas that needed to be addressed before further ATTs are permitted.
A significant issue that arose was the ability of ATTs in some practices to meet the criteria for identification of the required number of oedematous reactions to the skin test while training. To address this, APHA agreed that ATTs could observe and record these reactions in any test, not just their own, and they could travel to areas where these types of reaction are more common in order to meet the requirement. A post-pilot review including detailed feedback from the veterinary supervisors on this aspect concluded that the total number of reactions required should be maintained at 80, but that the total number of oedematous and circumscribed reactions could be lowered to a minimum of 20 of each (rather than 30) without compromising standards.
Feedback was very positive from farmers who praised the ATTs for their high-quality TB testing, professionalism and cattle handling skills. Feedback from ATTs, supervisors, practices and farmers indicates that farmers were very accepting of the role, impressed with the high standard of training and requested that ATTs return to carry out future testing. There was only one report of a significant challenge regarding a test result which required the supervisor to attend the farm.
Feedback from veterinary supervisors indicated that the level of supervision required was manageable and that they would be willing to train and supervise further ATTs. Whilst there was some variation in responses, the conclusion was that in order to perform the role to the required level, the maximum number of ATTs for which a supervisor has main responsibility should not exceed two and only one of those should be in training at any given time. Some supervisors commented that the ATT role improved their job satisfaction both in terms of having a supervisory role and also in being able to concentrate on more clinical work once the ATT was able to test without direct supervision.
Following a review of the pilot, APHA recommended that the use of ATTs be rolled out more widely in England, subject to certain conditions. Those conditions are required to provide assurance that the standards of QA and supervision of ATTs are maintained through ongoing monitoring and management by APHA. This recommendation was fully supported by the Defra TB Strategy Board and has subsequently received ministerial approval.
There are several new processes that need to be implemented before ATTs can be used more widely. In order to ensure a smooth transition, and so that APHA can continue to closely monitor ATTs, it is essential that all these processes are implemented and fully tested prior to the rollout. It is anticipated that rollout will commence from late 2020.
All veterinary businesses in England, not only those carrying out TB testing for VDPs, will have the opportunity to employ ATTs subject to providing the requirements. ATTs will be permitted to carry out all skin test types with the exception of tests required for any export purposes. Subcontracted or “locum” ATTs will be permitted, but all ATTs must work within a veterinary-led team and meet the strict veterinary supervision requirements.
Full details on requirements and processes will be provided by the end of summer 2020. APHA issued a full OV Briefing Note providing links to the pilot report.