standards committee agenda for the meeting to be held on 27 april 2016 … · 2016-10-21 · sc apr...

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Standards Committee Agenda for the meeting to be held on 27 April 2016 at 10.15am

1. Apologies for absence, declarations of interest and minutes of the meeting held on 27 January 2016

2. Standards and Advice Update Paper attached

3. Matters for decision: a. Competition and commercial issues

b. Directing prescriptions

c. Review of the 12 Principles of Certification

d. Feline Renal Transplants

e. Update on the review of Telemedicine and new technology tests

Papers attached

4. Matters for report:

a. Disciplinary Committee Report

b. Riding Establishments Sub Committee Report

Papers attached

5. Confidential Matters for report

a. Certification Sub Committee Report

b. Recognised Veterinary Practice Sub Committee Report

Papers attached

6. Any other business and date of next meeting 28 September 2016

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Standards Committee 2016 – 2017 Chairman: Mr David F Catlow BVSc MRCVS Vice-Chairman: Mr Christopher Barker BVSc MLitt CertVR MRCVS

Members:

Mrs Elaine Acaster OBE DipDSc Dip Dietetics

Mrs Lucy Bellwood RVN -Veterinary Nurses’ Council Representative

Professor Ewan Cameron BVMS PhD MRCVS

Mrs Jo Dyer BVSc, DipM, MRCVS

Ms Mandisa Greene BSc BVMS MRCVS

Prof Stephen May MA VetMB PhD DVR DEO DipECVS FHEA FRCVS

Mrs Jacqui Molyneux BVSc BSc CertSAS MRCVS

Dr Kate Richards BVM&S DipM MRCVS

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Meeting Standards Committee

Date 27 April 2016

Title Standards Committee minutes

Classification Unclassified

Summary The Committee is asked to adopt the minutes of the meeting held on 27 January 2016.

Decisions required None

Attachments Annexes have not been attached again as they have already been considered by the Committee.

Author Rebecca Rafferty Senior Advice Officer (Solicitor) 020 7227 3503 [email protected]

Laura McClintock Standards and Advisory Manager / Solicitor 0207 202 0763 [email protected]

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Standards Committee Minutes of the meeting held on 27 January 2016

Members: Mr David Catlow - Chairman

Mr Christopher Barker - Vice Chairman

Mrs Elaine Acaster

Mrs Lucy Bellwood - Veterinary Nurses’ Council Representative

Professor Ewan Cameron

Mrs Joanna Dyer

Ms Mandisa Greene

Professor Stephen May

Ms Jacqui Molyneux

Dr Katherine Richards

In attendance: Dr Christopher Tufnell - Junior Vice President / Committee Observer

Mrs Eleanor Ferguson - Head of Professional Conduct

Ms Laura McClintock - Standards and Advisory Manager / Solicitor

Mrs Rebecca Rafferty - Senior Advice Officer (Solicitor)

Mrs Julie Dugmore - Head of Veterinary Nursing

Present for Agenda Item 03(a)

Ms Natalie Heppenstall

- Standards and Advice Officer

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Welcome, Apologies and Declarations of Interest

1. The Chairman welcomed everyone to the meeting. Apologies were received from Ms Greene and

Professor Cameron.

2. Specific declarations were made by Dr Richards and Professor May in connection with agenda items 3(d) (fitness to practise and student veterinary nurses) and 4(a) (competition and commercial issues) respectively.

Minutes 3. The Committee adopted the minutes of the meeting held on 30 September 2015.

4. There was one matter arising relating to telemedicine. Mrs Molyneux reminded the Committee

that at its last meeting, it agreed that work would be undertaken to launch a ‘select committee’ style evidence gathering exercise on the subject of telemedicine. The Science Advisory Panel (SAP) met on 26 January 2016 and expressed concern that telemedicine was not on the Standards Committee agenda for 27 January 2016. Mrs Molyneux had agreed to raise this with the Committee and express the SAP’s views that this is a very pressing issue that must be addressed this year.

5. The Chair acknowledged what was agreed in September but advised that the matter had been put

on hold until 2017. Ms Ferguson explained that the Operational Board had looked at the College’s priorities for 2016 and decided that with all that was going on telemedicine could wait until 2017. Ms Ferguson explained that Council approved the 2016 list of priorities at their meeting in November 2015, including the decision regarding telemedicine.

6. The Chair noted the strong mood within the Committee that the plans to consider telemedicine

cannot wait until 2017 and must be progressed in the interests of staying ahead of any developments in an area that will have significant legal, ethical and regulatory implications. Ms Ferguson said she will provide feedback to the Operational Board and the Chair suggested that between now and the next Committee meeting in April there will need to be further deliberations on the next steps, including how to consult with the profession.

Standards and Advisory Update 7. The Committee noted the update paper and made specific comment on the following two items:

a. The Kennel Club reporting scheme

The Committee acknowledged the views obtained from external stakeholders including the BVA and BSAVA. Some members of the Committee expressed concern about the aims of the scheme and the commercial reality for veterinary surgeons that may discourage reporting. Overall, however, it was acknowledged that RCVS supporting guidance does not say that veterinary surgeons must make reports to the Kennel Club, or even suggest that veterinary surgeons should make reports; simply that they may. On this

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basis, it was agreed that the supporting guidance will remain as it is.

b. Standards and Advice Team Review of the Year The Chair expressed thanks to the Standards and Advice Team for all the work done over the last year. He highlighted in particular the examples of unprompted feedback received by the team in response to the advice they give to members of the profession, the public and stakeholders. The Committee suggested that the team share this with the Communications team with a view to some PR activities. It was also noted that the volume of calls handled by the team is similar to the volume handled by the Veterinary Defence Society (VDS).

Action: Standards and Advice Team Matters for decision Feline Renal Transplants 8. The Committee noted the report of the Science Advisory Panel (SAP): Feline Renal

Transplantation – Scientific Support to Develop an Ethical Position (December 2015). The Committee recognised the value of the report and expressed their appreciation for the hard work undertaken by the SAP.

9. The Committee did not feel able to make a recommendation at this time as to a direction of travel and could only recommend that the issue is referred to Council for further consideration and debate. The Committee debated the issue at length and agreed that the following should be brought to Council’s attention:

a. It was acknowledged that the SAP was specifically instructed to consider the single issue of

feline renal transplantation but the Committee considered that perhaps the College should be considering the issue of transplantation generally. Regardless of tissue type, many of the legal, ethical and scientific issues will be the same and perhaps therefore a universal position and framework should be considered. It was acknowledged that what might not be possible today could be possible in a few years’ time.

b. Thinking about transplantation generally, the Committee acknowledged that corneal transplantation occurs routinely at various centres in the UK, although this might not be common knowledge. Tissue is taken from patients post-euthanasia.

c. There was much discussion about the ‘pre-euthanasia’ donor. Overall, it was acknowledged

that the pre-euthanasia donor is still a living source donor. As such, from a legal perspective, to remove a kidney from a pre-euthanasia donor is an unnecessary mutilation; a criminal offence. The Committee accepted the conclusion at paragraph 20 of the SAP’s report:

We recommend that the RCVS does not support the use of living source donors for feline renal transplantation. This is based on legal opinion. It is also contrary to a basic tenet of veterinary practice that inflicting pain and discomfort on an animal can only be justified as an act of veterinary surgery if it is for the benefit of the animal receiving that pain and discomfort.

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d. Putting the legal issues to one side (which of course can only be done hypothetically) concerns were expressed about the sourcing of the pre-euthanasia donor. The Committee emphasised that the decision to euthanase had to be a clinical one. The Committee queried how we could ever be assured of the soundness of the decision to euthanase and the notion of perverse human behaviour was discussed. The Committee considered that safeguards and assurances would need to be in place to prevent the manufacturing of euthanasia situations, but how these could be achieved in practice is unknown. There was also some concern that there was ‘slippery slope’ potential and that animals in shelters may not be adequately protected if supply and demand was not satisfied by the clinical euthanasia cases. The SAP report itself included the comment:

In these cases [cases of illness or injury in cats (e.g. tail-pull injuries) where euthanasia is best] there is an ethical argument that it is reprehensible NOT to make use of discarded healthy tissues to benefit other animals.

It was acknowledged that this was based on the opinion of a human transplant surgeon but there was concern about extrapolation of the arguments.

e. It was suggested that the concerns about sourcing apply equally to dead donors. As with pre-

euthanasia donors, how are we to be assured that the euthanasia decision was made on clinical grounds and not influenced by perverse human behaviour? How can we be satisfied that animals that should not be consigned to euthanasia will not be?

f. It was felt that there has to be great consideration of quality of life for the recipient. If we think specifically about feline renal transplantation, is this an effective treatment? Health benefits have to be considered alongside welfare implications. The Committee highlighted the following comment from the SAP report:

It was noted that there was only anecdotal evidence from the US about improvement in the quality of life for recipients and that there was no significant body of literature to support it.

g. Concerns were also expressed about the health and welfare of the pre-euthanasia donor in

the inevitable gap between the decision to euthanase and the act itself; presumably there will be a delay while efforts are made to find a recipient, as well as any transporting. Once it has been decided that euthanasia is in the animal’s best interests, is it wrong to delay this and expect nursing care to be provided?

h. There was a suggestion of a tightly controlled test period or trial, in which all proposed cases of feline renal transplantation would have to be registered with the College. The College could take a proactive role and monitor each case and enquire as to the decision-making processes, specifically the decision to euthanase the donor. There is of course the unsolved legal issue – would we be complicit in what we consider to be unnecessary mutilations?

Action: Chair to report to Council

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Delegating to practice lay staff 10. The Committee approved additional guidance to be added to chapter 19 of the supporting

guidance (treatment of animals by unqualified persons) on the topic of delegation to practice lay staff. It was acknowledged that the guidance derives from the VN Standard article, Legally Speaking, of August 2010.

11. There was a discussion about whether chapter 18 of the supporting guidance (delegation to veterinary nurses) should be expanded to include the topic of nurse clinics. On balance, however, it was felt that this was not advisable at the current time, principally because of the review of Schedule 3 which might necessitate a broader review of the guidance on delegation to veterinary nurses.

12. The Committee did, however, agree that veterinary nurses can make observations and can

recognise abnormalities. The Committee agreed that the veterinary nurse who recognises an abnormality is not making a diagnosis and their proper role is to bring that to the attention of a veterinary surgeon. They should be careful, however, about how far they go and in their communications with clients. A copy of the final guidance is attached at Annex A.

Action: Standards and Advice Team

Updated veterinary care guidance 13. Overall, the proposed amendments to chapter 2 of the supporting guidance (veterinary care) were

approved, subject to some minor revisions. It was, however, acknowledged that the new chapter is considerably longer than the existing and the Committee reminded itself that the College should not seek to be overly prescriptive, particularly bearing in mind the rationale for the transition from the Guide to Professional Conduct to the Code of Professional Conduct. These comments were noted but Ms McClintock and Mrs Ferguson explained that the appetite to expand this particular chapter came chiefly from the increasing number of concerns reaching the Preliminary Investigation Committee on issues of veterinary care, most commonly discharge of patients. A copy of the final guidance is attached at Annex B.

14. The Committee was asked to note two recent enquiries taken by the Standards and Advice Team

on issues of veterinary care:

a. A member of the public had expressed concern that the College does not insist on there being someone on-site in a veterinary practice overnight where there are inpatients. The Committee acknowledged that this is not possible for all practices and what is key is that clients are informed in advance of the level of staffing overnight. Clients are then free to make a choice.

b. A veterinary surgeon had suggested that in the interests of continuity of care, the College should make the transmission/availability of records out-of-hours compulsory. It was acknowledged that there is just too much incompatibility between practice record systems for this to be possible.


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Fitness to practise and student veterinary nurses 15. Dr Richards declared that she is on the Board of SRUC, a provider of veterinary nursing

education.

16. There was brief discussion about how the guidance is intended to prepare nursing students to enter a regulated profession, but it is not intended to prevent them from enjoying university life. The guidance acknowledges that students are not fully fledged professionals and makes allowance for this. There was also brief discussion of health cases. It was noted that the guidance recognises that concerns may arise from matters related to physical or mental health and may involve substance abuse. However, ideally such matters will be identified and addressed before they become fitness to practise concerns, with appropriate input and support from the educational provider, which may include occupational health.

17. Overall, the Committee endorsed the guidance produced by the Working Party and arrangements

can now be made for its publication.

Action: Standards and Advice Team Compulsory microchipping update 18. The Committee noted that the Welsh Regulations are now published but we await sight of the

Scottish Regulations. The Committee agreed that the guidance on compulsory microchipping at chapter 29 of the supporting guidance (microchips, microchipping and animals without microchips) should be updated to reflect the position in Wales. The Committee will await news in respect of Scotland.

Action: Standards and Advice Team Direction of prescriptions 19. There were mixed views within the Committee on the appropriateness or otherwise of veterinary

surgeons making specific directions to online pharmacies on their written prescriptions.

20. Some members considered that the issue cannot be considered in isolation, recognising that veterinary surgeons make directions and recommendations every day, whether it be the recommendation of a particular farrier, direction to a referral centre or the prescription of a specific medicinal product. With this in mind, why should we treat the direction of prescriptions any differently?

21. On the other hand, some members felt strongly that the direction of prescriptions is inappropriate.

The very reason for making prescriptions available to clients is to allow them choice as to where they source their veterinary medicines. It was considered that to permit veterinary surgeons to direct prescriptions is to undermine this principle.

22. It was agreed that to consider the matter further we should take advice from the Competition and

Markets Authority (CMA). The predecessor to the CMA, the Office of Fair Trading (OFT), agreed

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‘fair trading’ principles with the College as an alternative to legislation and so we should take the CMA’s views on how this activity sits with those principles. Depending on what the CMA say, we may then wish to discuss the matter with the Veterinary Medicines Directorate (VMD) who are responsible for the Veterinary Medicines Regulations which determine the components of a written prescription.


Reporting suspected illegal imports 23. The Committee approved additional guidance to be added to chapter 14 of the supporting

guidance (client confidentiality) to cover the topic of reporting suspected illegal imports. The Standards and Advice Team receives frequent enquiries on this issue and the new guidance will echo the comments of the Registrar publicised in the Veterinary Record in February 2015. A copy of the final guidance is attached at Annex C.


Confidential matters for decision: Competition and commercial issues – topical considerations (Confidential paper, unclassified minutes) 24. Professor May declared his interest in the Queen Mother Hospital for Animals insofar as this was

relevant to the discussions.

25. There was discussion about the ways in which practices outside of an insurer’s preferred supplier network can remain competitive, namely by offering discounts on veterinary fees to ensure that clients would be no worse off if they chose to use their services rather than a practice within the network. There was also discussion about practice policies for staff discounts and the relationship between such policies and pet insurance policies. There were mixed views within the Committee when discussing the presentation of claims to an insurance company and the net result. It was considered that supporting guidance should be produced to guide the profession on how to act openly and with integrity in such matters. This may necessitate a re-think of the wording at 9.19 of the supporting guidance (the concept of the ‘normal practice fee rate’) which appears to cause some confusion.

26. The Committee also discussed the issue of incentives or ‘kickbacks’ in the referral setting. Again,

views ranged, but it was agreed that supporting guidance should be produced to flag the various considerations for the profession, including the situations where declarations should be made to clients.

27. The Committee considered what had been labelled as ‘expectations of exclusivity’, namely where

practice policies operate such that clients who shop around for veterinary services are penalised, perhaps resulting in the termination of services. The Committee had been asked to consider whether this represents a restriction of freedom of choice but the Committee considered that if a

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practice wishes to have such a policy, it should be clearly included in the practice’s terms and conditions and drawn to the client’s attention.

28. Amendments to chapter 1 of the supporting guidance (referrals and second opinions) were also

agreed to clarify that veterinary surgeons may refer to colleagues and institutions, and to state that reports for the referring veterinary surgeon should be dealt with by the person who saw the case so that there is transparency.


Matters for report:

a. Disciplinary Committee Report The Committee noted the report.

b. Riding Establishments Sub Committee Report The Committee noted the report, specifically the Defra review of animal licensing

legislation.

Confidential matters for report: 29. The Committee considered the following confidential matters for report:

a. Certification Sub Committee Report The Committee noted the report and the substantial piece of work being undertaken to review the 12 Principles of Certification. Revised supporting guidance on certification will come before the Committee in due course.

b. Recognised Veterinary Practice Sub Committee Report

The Committee noted the report.

Any other business

30. The Committee discussed recent information regarding local authority schemes for addressing dog fouling. The Committee was informed of one local authority’s plans to tackle dog fouling which involved the registration of dogs’ DNA, to be facilitated by the veterinary profession. Some Committee members had heard of similar ideas in other parts of the country and the USA. It was agreed that the College should write to the local authority to ask them to explain the plans in more detail so that the College can properly consider the involvement of the profession and advise its members accordingly.

Action: Standards and Advice Team Date of the next meeting 31. The date of the next meeting is 27 April 2016.

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Date 27 April 2016

Title Standards and Advice Update


Summary This paper provides a brief update on a number of ongoing matters dealt with by the Advice Team from the date of the last meeting on 27 January 2016, which the Standards Committee is asked to note.


Attachments None

Author Laura McClintock Standards and Advisory Manager / Solicitor 0207 202 0763 [email protected]

Natalie Heppenstall Standards and Advisory Officer 0207 202 0757 [email protected]

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Standards and Advice Update (April 2016) Below is a brief report updating the Standards Committee on a number of ongoing matters dealt with by the Advice Team from the date of the last meeting on 27 January 2016. Fitness to practise: A Guide for UK Providers of Veterinary Nursing Education and Student Veterinary Nurses 1. In January, Standards Committee endorsed new fitness to practise guidance drafted by the Advice

Team and approved by a Working Group, which included representatives from a cross-section of awarding organisations, training providers, the BVNA (providing a voice for the student body) and RCVS Veterinary Nurses Council. This work was reported to RCVS Council in March 2016. Following on from the Council meeting, the guidance document has now been published and hard copies will be distributed to awarding organisations, training providers and veterinary nursing students. The document can also be downloaded from the publications section of the RCVS website (see http://www.rcvs.org.uk/publications/)

Compulsory microchipping 2. Standards Committee recently approved new guidance for both veterinary surgeons and veterinary

nurses regarding the compulsory obligation to microchip dogs in England, Scotland and Wales (microchipping of dogs has been mandatory in Northern Ireland since 2012). Since January, the Advice Team has responded to a significant number of telephone and written enquires from veterinary surgeons and veterinary nurses on how the new regulations apply in practice. For the most part enquirers have advised that they initially sought guidance from Defra, but were redirected to the RCVS.

3. Defra have previously advised us that they would be drafting their own guidance on the regulations

for stakeholders and the public, but this has not been provided yet. We have now been advised that Defra still intend to publish some practitioner notes, which will include a Q&A document. We understand this has been delayed because of the new questions being received.

4. The Committee is aware that there are ‘health’ exemptions from the general microchipping requirement and below are some updates on the progress of the exemption certificates:

a) In Wales, the exemption applies for as long as a veterinary surgeon certifies, on a form approved by the Welsh Ministers, that microchipping would significantly compromise the dog’s health. The certificate must state the period for which the dog will be unfit to be microchipped. The Welsh Government sought our advice on the drafting of the certificate and feedback was provided by the Certification Sub-Committee. The certificate has now been circulated to key stakeholders.

b) In England, the exemption applies for as long as a veterinary surgeon certifies, on a form approved by the Secretary of State, that a dog should not be microchipped for reasons of the animal’s health. The certificate must state the period for which the dog will be unfit to be microchipped. Defra did not seek our advice on the drafting of the certificate, but did provide us with a copy. The Certification Sub-Committee identified some potential issues with the current draft of the certificate and highlighted these to Defra. One issue is that the

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certificate does not include a section relating to the date of the certificate / examination. We have advised Defra this should be included and we are suggesting that in the meantime veterinary surgeons include the date when signing the document.

c) In Scotland, the exemption applies for as long as a veterinary surgeon certifies that a dog should not be microchipped for reasons of the dog’s health. The certificate must state the period for which the dog will be unfit to be microchipped. There is no official certificate to be used in Scotland.

Ethics Review Panel (ERP) for practice-based research 5. The Committee is aware that the new RCVS Ethics Review Panel (ERP) will run for a one-year trial

and provide a mechanism of ethical review for practice-based researchers, who may not normally have access through university or industry connections. The trial has been endorsed by the BVA, BSAVA and BVNA, the latter two offering to provide mentors to assist veterinary surgeons and veterinary nurses respectively and to provide guidance on planning and structuring research projects prior to submitting proposals for ethical review. The Advice Team has been responsible for getting the new ERP up and running and will also manage the general work and administration of this new group.

6. On 17 February, we held a strategy meeting with representatives from the BSAVA, BVA and BVNA

to discuss practical arrangements for the new ERP. Discussions included topics such as confirmation of ERP terms of reference; panel constitution and recruitment; training of panel members; the application process; and ethical-decision making.

7. On 16 March, we started recruiting for four veterinary surgeons (to include one practising veterinary

surgeon and three veterinary surgeons each with experience of clinical research in one of the following areas: medical, surgical and qualitative) as well as one registered veterinary nurse. These roles will complement panel members including the Chair (who is a veterinary surgeon and ethicist) and a lay member. Potential applicants were asked to submit a copy of their CV and complete an application form. The closing date for applications is 15 April 2016.

8. Once the full ERP has been recruited, there will be a training day for all members in June 2016.

Our joint partners in the trial (BSAVA and BVNA) will also be attending the training sessions. Speakers will cover key areas such as Codes of Practice relating to clinical research; the interface between the Veterinary Surgeons Act and the Animals Scientific Procedures Act; common ethical issues; assessing benefit and harm; study design issues; and handling sensitive information and privacy.

9. The work of the ERP was further promoted at the BSAVA Congress in April. This included a

number of lectures via the JSAP/Pet-Savers stream, including lectures on ‘How to get ethical review if you don’t work at a university’. We also worked with the Communications Team to produce postcards for veterinary surgeons and veterinary nurses reminding them about the new ERP and how to apply. These were distributed over the course of the BSAVA congress.

10. The ERP will begin considering research proposals from veterinary surgeons and veterinary nurses

from 1 August 2016. The process will be limited to proposals containing cats and/or dogs during the trial period, with the possibility of expanding to other species if the trial is extended or made permanent.

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11. The Advice Team is also in the process of drafting the ethical review application form and

associated written guidance for veterinary surgeons and veterinary nurses seeking ethical approval of clinical research proposals. The guidance covers key areas such as understanding when clinical practice becomes research; the different types of research that might require ethical review; the need and purpose of ethical review; and, how to apply for ethical approval. The guidance also details the information required from applicants, for example, study details and description (including details of proposed sample size, statistical power, background and methodology etc); benefits and risk analysis; ethical or welfare issues; access to data; and, owner consent. Added to this, the Advice Team is working on similar guidance for members of the ERP.

Annual meeting between the RCVS, Home Office and the Laboratory Animals Veterinary Association (LAVA) 12. The RCVS meets annually with the Home Office and the Laboratory Animals Veterinary

Association (LAVA) to discuss issues of mutual interest such as guidance for those working in the role of a 'Named Veterinary Surgeon' (NVS) in scientific procedure establishments or breeding and supplying establishments as well as any issues related to the interface between the Veterinary Surgeons Act 1966 and the Animals (Scientific Procedures) Act 1986, specifically around recognised veterinary practice. The meeting is chaired by the RCVS President and members of the RCVS Recognised Veterinary Practice Sub Committee are also invited to attend. The next meeting is scheduled for the 19 April 2016 and the minutes will be provided to Standards Committee for information in due course.

Discussions with the UK Reiki Federation

13. Previously, at its September 2012 meeting, Standards Committee considered the issue of animal behaviourism and, whilst so doing, considered whether it would be appropriate for RCVS Supporting Guidance on treatment of animals by unqualified persons to include examples or a list of complementary therapies. The Committee took the view that guidance from the RCVS should be as broad as possible and that reference to specific types of complementary therapy should be avoided so as not to suggest that the RCVS endorsed the efficacy of any therapy over another. The current guidance simply states that all forms of complementary therapy that involve acts or the practise of veterinary surgery must be undertaken by a veterinary surgeon, subject to any exemption in the Act.

14. Separate to this, the UK Reiki Federation recently contacted the RCVS to request a meeting to discuss the relationship between reiki and the Veterinary Surgeons Act, which they were concerned was overly restrictive on reiki practitioners. The meeting took place on 15 February 2016 and was attended by the Chair of Standards Committee.

15. At the meeting, the UK Reiki Federation expressed some concerns about historical guidance from the RCVS, specifically whether all animals must be seen by a veterinary surgeon prior to reiki being given. We advised that there seemed to have been a misunderstanding in relation to whether reiki could be undertaken without a referral. We explained that with physiotherapy, for example, the legislation allows for the treatment of animals by physiotherapy, provided that the animal has first been seen by a veterinary surgeon who has diagnosed the condition and decided that it should be treated by physiotherapy under his/her direction. There is no such legal requirement relating to

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reiki. The historical and informal advice was that it is advisable for practitioners to ensure that vets were happy for reiki healing to be given, but that this was not a legal requirement and essentially served to protect animal welfare and also the reiki practitioner from allegations of breaching the Veterinary Surgeons Act by making a diagnosis.

16. The Federation also requested that specific reference was made to reiki in the Supporting

Guidance on complementary therapies within Chapter 19. They were advised that, as a result of the decision taken by Standards Committee in September 2012 (detailed above), it would not be appropriate to do so.

Update on antimicrobial resistance (AMR) strategy

17. Standards Committee will recall previous discussions on whether more could be done, via the

Code and Supporting Guidance, to promote responsible use, particularly since antimicrobial resistance continues to be an area of focus in both the human healthcare and veterinary sectors. Overall, the Committee decided that the current guidance remains appropriate, but did agree to update this to include links to other publications and specific advice to assist practitioners in making informed and professional choices. Links to these additional sources have now been included in the Supporting Guidance.

18. Separate to this, we recently met with the Veterinary Medicines Directorate to discuss, in practical terms, what VMD Inspectors / PSS Assessors should be looking for when they visit practices in terms of responsible use of antimicrobials. The VMD AMR team explained that the profile of AMR continues to be on the increase and the public may jump to the wrong conclusion that there is unregulated use in the veterinary sector. Veterinary surgeons are the gatekeepers of antibiotic use in their own sector and the VMD is seeking to demonstrate that members of the profession are role models.

19. We provided the VMD with an update on what PSS Assessors will be looking for during practice

visits. Assessors will be looking for evidence that the practice has considered and discussed the use of antimicrobials, and drawn up their own protocol for use in the practice. This needs to be done properly and Assessors will be looking to see whether these protocols are being used. They will speak with members of the veterinary team to ensure they understand and use the protocol. Although Assessors will not review the clinical notes or challenge the content of the protocol (as this is a matter of clinical freedom for the practice), they will check there is a due process in place. General prescribing and dispensing protocols are also checked as pat of the assessment. AMR is also covered at joint VMD / PSS training days.

20. The VMD were reassured by the process, which they felt was satisfactory. We also highlighted

that although the RCVS is not in a position to set clinical specific guidelines, we do focus on education, including referencing sources of advice in the Supporting Guidance to the Code of Professional Conduct. The VMD AMR team offered to produce the additional leaflet for clients – and highlight any additional sources of information for veterinary surgeons and veterinary practice.

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Date 27 April 2016

Title Competition and commercial issues


Summary At its previous meeting in January 2016 the Committee discussed a number of topics relating to the commercial aspects of veterinary practice. The Committee agreed, in principle, to additions and amendments to the supporting guidance to reflect the issues discussed.

Decisions required To approve additions and amendments to the supporting guidance on various commercial aspects of veterinary practice that could raise professional conduct issues.

Attachments Annex A: Suggested amendments and additions to chapter 9 of the supporting guidance Annex B: Suggested additions to chapter 1 of the supporting guidance

Author Rebecca Rafferty

Senior Advice Officer (Solicitor)

020 7227 3503

[email protected]

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Competition and commercial issues

Background

1. At its previous meeting in January 2016 the Committee discussed a number of topics relating to the commercial aspects of veterinary practice. The Committee agreed, in principle, to additions and amendments to the supporting guidance to reflect the issues discussed, namely, discounts on veterinary fees, animal insurance, and incentives and kickbacks.

Discounts and animal insurance 2. The January discussions focused heavily on the complications that might arise when practice

policies for staff discounts interact with individual policies of animal insurance.

3. There were mixed views within the Committee about the proper application of any policy of staff discounts and the related issues of: whether it is acceptable to distinguish between insured and non-insured staff, the presentation of claims to an insurance company, and whether a practice has the right to waive any excess.

4. It was considered that supporting guidance should be produced to guide the profession on how to act openly and with integrity in such matters. However, in light of the differing opinions within the Committee itself, and therefore the anticipated difficulties in agreeing new practical guidance, the Committee is asked to consider whether the following existing statements (emphasis added) in chapter 9 of the supporting guidance (‘practice information, fees and animal insurance’) are sufficient and as far as the College ought reasonably go on this matter:

9.18 Veterinary surgeons must act with integrity in all dealings with an animal insurance policy. They must complete claim forms carefully and honestly. A veterinary surgeon who acts dishonestly or fraudulently may be liable to criminal investigation and/or disciplinary action.

9.19 Veterinary surgeons treating an animal covered by an animal insurance policy should charge the normal practice fee rate. When completing the insurance claim form, the veterinary surgeon should include the amounts actually paid or, in the case of direct claims, the amounts actually charged, with any additional or administrative charges shown separately. Any material fact that might cause the insurance company to increase the premium or decline a claim must be disclosed. Failure to complete claim forms in this way may raise suspicions of dishonesty or fraud, and may result in a complaint being made to the police and/or RCVS. A veterinary surgeon in any doubt as to how to complete a particular claim form accurately should, wherever possible, discuss this with the insurance company.

5. As for general guidance on discounts (not just staff discounts) it is proposed that the following new paragraph of guidance is added (as demonstrated at Annex A) beneath the existing guidance on animal insurance: Discounts on veterinary fees Veterinary practices have the commercial freedom to offer discounts on their fees on terms set by them. This might include discounts for members of staff, discounts for early settlement and

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discounts for certain clients e.g. students, pensioners etc. Some providers of pet insurance will also have arrangements with various veterinary practices under which discounted fees for clients insured with that provider have been agreed. Discounts generally are acceptable but there should be transparency as to the availability of discounts and the related terms and conditions. It is never acceptable, however, to present a client with inflated fees so as to create the fiction of a discount. In addition, while the selective discounting of fees is acceptable, the selective inflation of fees is not.

6. The Committee is also asked to consider removing the current opening phrase to 9.19, as it wasrecognised that this has been causing some confusion:

9.19 Veterinary surgeons treating an animal covered by an animal insurance policy should charge the normal practice fee rate.

It is proposed that the last sentence of the new text proposed above (highlighted) better reflects the true meaning behind ‘the normal practice fee rate.’

7. The proposed changes to chapter 9 are summarised in full at Annex A and the Committee isasked to approve these.

Incentives and ‘kickbacks’

8. The Committee will recall its discussions in January relating to incentives and kickbacks. Theissue was considered in the specific context of referrals, but the Committee acknowledged thatveterinary surgeons and veterinary nurses may offer / be offered incentives in other aspects ofveterinary practice.

9. There was a difference of opinion within the Committee on the very principle of offering andaccepting incentives. Some members felt very strongly that to offer or accept an incentive breaksthe basic principle of professionalism. It was acknowledged that the General Medical Council alsotakes a purist view – doctors are advised that they must not accept any inducement, gift orhospitality that may affect or be seen to affect the way they prescribe for, treat or refer patients orcommission services for patients. Neither must they offer such inducements.

10. Other Committee members supported a position whereby the individual professional is free tomake a decision on offering / accepting an incentive but agreed that the College should encouragethem to carefully consider disclosing that incentive to clients. This is the approach that has beentraditionally advocated by the College. It was suggested that the question of whether to discloseor not is one of degree, and it was acknowledged that there could be some practical issues, forexample, if a vaccine company gave a practice £1,000 towards CPD for staff, does every clientwho has their pet vaccinated with that product need to be informed of the incentive?

11. Notwithstanding the range of views, it was agreed that supporting guidance should be produced toflag the various considerations for the profession, including the situations where declarationsshould be made to clients.

12. The Committee is asked to approve the new guidance on ‘incentives’ at Annex B, which it is proposed is inserted in chapter 1 (‘referrals and second opinions.’)

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Preferred supplier networks

13. The Committee is aware of the discussions that have taken place regarding RSA’s preferred supplier network and will no doubt be aware that discussions continue to take place within the profession about the scheme and the direction of the animal insurance market more generally. The Committee will recall that initial publicity about the RSA scheme raised concerns about erosion of the freedom of the referring veterinary surgeon.

14. The Chair and members of the Standards and Advice Team attended a meeting on 30 March 2016 with representatives of the British Veterinary Association, British Small Animal Veterinary Association, Society of Practising Veterinary Surgeons and British College of Veterinary Specialists. This was an informal, round-table meeting with no minutes, to collate views and receive feedback from each organisation’s membership.

15. The meeting served as a reminder of the importance of the fundamental freedom of the referring

veterinary surgeon. The membership organisations considered that their members would appreciate reassurance in this regard to help them understand the proper scope of their responsibilities in the changing insurance market where we do now have preferred supplier networks.

16. The Committee is therefore asked to approve additional paragraphs of guidance at chapter 1 of

the supporting guidance, highlighted at Annex B as paragraphs 1.4 and 1.5.

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9. Practice information, fees and animal insurance Existing guidance in grey/blue New guidance and changes in red (see 9.17 onwards)

Practice information

9.1 Veterinary practices should provide clients, particularly those new to the practice, with comprehensive written information on the nature and scope of the practice's services, including:

a. the provision, initial cost and location of the out-of-hours emergency service; b. information on the care of in-patients; c. the practice's complaints handling policy, and could also provide full terms and conditions of

business, to include for example: i. surgery opening times ii. whether open or by appointment iii. fee or charging structures iv. procedures for second opinions and referrals v. use of client data vi. access to and ownership of records

Freedom of choice

9.2 Veterinary surgeons should not obstruct a client from changing to another veterinary practice, or discourage a client from seeking a second opinion.

9.3 If a client's consent is in any way limited or qualified or specifically withheld, veterinary surgeons should accept that their own preference for a certain course of action cannot override the client's specific wishes, other than on exceptional welfare grounds.

Fees

9.4 The RCVS has no specific jurisdiction under the Veterinary Surgeons Act 1966 over the level of fees charged by veterinary practices, unless they are so extreme as to constitute disgraceful conduct in a professional respect. There are no statutory charges and fees are essentially a matter for negotiation between veterinary surgeon and client.

9.5 Fees may vary between practices and may be a factor in choosing a practice, as well as the practice's facilities and services, for example, what sort of arrangements are in place for 'out-of-hours' emergency calls (eg are emergency consultations at the practice premises, or by another practice at another location).

9.6 Veterinary surgeons should include any estimated charge or fee on a consent form. In the event of a fee dispute, whether a client must pay a bill is a matter to be resolved between the parties or by the civil courts, therefore, in most cases, disputes about the level of veterinary surgeons’ fees fall outside the jurisdiction of the RCVS.

Invoices

9.7 All invoices should be itemised showing the amounts relating to goods including individual relevant medicinal products and services provided by the practice. Fees for outside services and any charge for additional administration or other costs to the practice in arranging such services should also be shown separately.

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Unpaid bills

9.8 A veterinary surgeon is entitled to charge a fee for the provision of services and, where the fee remains unpaid, to place the matter in the hands of a debt collection agency or to institute civil proceedings.

9.9 In the case of persistently slow payers and bad debtors, it is acceptable to give them notice in writing (preferably by recorded delivery) that veterinary services will be no longer provided.

Holding an animal against unpaid fees

9.10 Although veterinary surgeons do have a right in law to hold an animal until outstanding fees are paid, the RCVS believes that it is not in the interests of the animal so to do, and can lead to the practice incurring additional costs which may not be recoverable.

Prescriptions

9.11 Veterinary surgeons may make a reasonable charge for written prescriptions. (Prescriptions for POM-V medicines may be issued only for animals under the care of the prescribing veterinary surgeon and following his or her clinical assessment of the animals.)

9.12 The Supply of Relevant Veterinary Medicinal Products Order came into force on 31 October 2005 and is enforced by the Competition and Markets Authority. It implements recommendations from the Competition Commission and provides that veterinary surgeons must not discriminate between clients who are supplied with a prescription and those who are not, in relation to fees charged for other goods or services.

Re-direction to charities

9.13 All charities have a duty to apply their funds to make the best possible use of their resources. Clients should contact the charity to confirm their eligibility for assistance. The veterinary surgeon should ensure that the animal's condition is stabilised so that the animal is fit to travel to the charity, and provide details of the animal's condition, and any treatment already given, to the charity.

9.14 If the client is not eligible for the charitable assistance and no other form of financial assistance can be found, euthanasia may have to be considered on economic grounds.

Securing payment for veterinary services

9.15 A client is the person who requests veterinary attention for an animal, for example when a veterinary surgeon is called to the scene of a road traffic accident by the police or by the RSPCA, the organisation in question will be liable to pay for any emergency treatment and for the call out, even if the animal owner is subsequently identified (because the owner had no opportunity to consent to treatment).

EU Directive 2006/123/EC on the provision of services

9.16 The EU Directive on services requires that service providers, which include veterinary surgeons, must give clients relevant information, such as their contact details, the details of their regulator and the details of their insurer. Certain information must be provided on request, such as the price of a service or, if an exact price cannot be given, the method for calculating the price.

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Animal insurance

9.17 An animal insurance policy is a contract between the animal owner and the insurer. The veterinary surgeon is a third party to this contract. Animal insurance schemes rely on the integrity of the veterinary surgeon, who has a responsibility to both the client and insurance company.

9.18 Veterinary surgeons must act with integrity in all dealings with an animal insurance policy. They must complete claim forms carefully and honestly. A veterinary surgeon who acts dishonestly or fraudulently may be liable to criminal investigation and/or disciplinary action.

9.19 Veterinary surgeons treating an animal covered by an animal insurance policy should charge the normal practice fee rate. When completing the insurance claim form, the veterinary surgeon should include the amounts actually paid or, in the case of direct claims, the amounts actually charged, with any additional or administrative charges shown separately. Any material fact that might cause the insurance company to increase the premium or decline a claim must be disclosed. Failure to complete claim forms in this way may raise suspicions of dishonesty or fraud, and may result in a complaint being made to the police and/or RCVS. A veterinary surgeon in any doubt as to how to complete a particular claim form accurately should, wherever possible, discuss this with the insurance company.

9.20 In cases where the veterinary surgeon is treating an animal with a long-term or ongoing health condition under an animal insurance policy, the practice of asking clients to pre-sign blank claim forms for subsequent completion and submission by the veterinary surgeon may expose the veterinary surgeon to suspicions of dishonesty or fraud. If the veterinary surgeon adopts this method, or indeed in any situation where the veterinary surgeon will send the claim directly to the insurance company, it is good practice to send a copy of the completed claim form to the client before submission so that they can check the details of the claim. In the reverse situation, where the client submits the claim form directly to the insurance company, it is advisable for the veterinary surgeon to keep a copy of what they send to the client so that there is a record in the event of any subsequent queries. Additionally, veterinary surgeons should not sign blank insurance claim forms.

9.21 Particular care should be taken when the veterinary surgeon is treating their own animal, or an animal belonging to a family member or a close friend, and that animal is covered by an animal insurance policy. Generally, such conflicts of interest should be avoided. For that reason, it is advisable to get another veterinary surgeon to complete, sign and submit the claim form, wherever possible. Where this is not possible, the veterinary surgeon should state on the form the ownership of the animal.

9.22 Animal insurance may enable relevant veterinary investigations or treatment to be carried out in circumstances where fees might otherwise be unaffordable for the animal owner. A veterinary surgeon should, however, ensure that the investigation or treatment is appropriate and is in the animal’s best interests.

9.23 Veterinary surgeons and veterinary nurses should not be seen to favour any particular insurer, unless they are registered with the Financial Conduct Authority or formally linked with a registered insurer. If a practice wishes to display promotional material, it is prudent to display a range so as to avoid any implication of bias, financial advice, or brokering. If any commission may be paid to the veterinary surgeon, veterinary nurse or support staff in the event that a particular policy is taken out, this should be disclosed.

Discounts on veterinary fees

9.24 Veterinary practices have the commercial freedom to offer discounts on their fees on terms set by them. This might include discounts for members of staff, discounts for early settlement and discounts for certain clients e.g. students, pensioners etc. Some providers of pet insurance will also have arrangements with various veterinary practices under which discounted fees for clients insured

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with that provider have been agreed. Discounts generally are acceptable but there should be transparency as to the availability of discounts and the related terms and conditions. It is never acceptable, however, to present a client with inflated fees so as to create the fiction of a discount. In addition, while the selective discounting of fees is acceptable, the selective inflation of fees is not.

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SC Apr 16 AI 03(a) Annex B

1. Referrals and second opinionsExisting guidance in grey/blue New guidance in red

Introduction

1.1 Veterinary surgeons should facilitate a client’s request for a referral or second opinion.

1.2 A referral may be for a diagnosis, procedure and/or possible treatment, after which the case is returned to the referring veterinary surgeon, whereas a second opinion is only for the purpose of seeking the views of another veterinary surgeon. Neither a second-opinion veterinary surgeon nor a referral practice should ever seek to take over the case, unless the client chooses to change practices.

When to refer

1.3 Veterinary surgeons should recognise when a case or a treatment option is outside their area of competence and be prepared to refer it to a colleague, organisation or institution, whom they are satisfied is competent to carry out the investigations or treatment involved.

1.4 The veterinary surgeon should make a referral appropriate to the case. When considering what is appropriate the veterinary surgeon should consider all relevant factors. These might include the location of the service, the urgency of treatment and the circumstances of the owner, including the availability and any limitations of insurance. Veterinary surgeons should be prepared to justify their referral decisions.

1.5 In cases where the client does not accept the veterinary surgeon’s advice regarding referral and would instead prefer referral to a colleague, organisation or institution of which the referring veterinary surgeon has insufficient knowledge to determine appropriateness, they may need to advise their client accordingly. In some such cases, the veterinary surgeon may consider that they cannot be party to such a referral relationship.

1.5 The referring veterinary surgeon has a responsibility to ensure that the client is made aware of the level of expertise of appropriate and reasonably available referral veterinary surgeons, for example, whether they are veterinary specialists or advanced practitioners. They must not describe a referral veterinary surgeon as a specialist, or as an advanced practitioner, unless they are on the respective list.

1.6 Both the referring veterinary surgeon and the referral veterinary surgeon have a responsibility to ensure that the client has an understanding of the likely cost arising from the referral.

Incentives

1.7 Veterinary surgeons and veterinary nurses may be offered various forms of incentives by third parties, and they may make such offers themselves. Incentives might arise in a number of settings, for example, a referral practice might offer an incentive to a referring veterinary surgeon. Incentives may take a number of forms, for example, cash, commission, or something with monetary value such as CPD courses or gadgets.

1.8 Veterinary surgeons and veterinary nurses considering offering or accepting any form of incentive should consider whether the existence of the incentive gives rise to a real or perceived conflict of interest. An incentive should not distract a veterinary surgeon or veterinary nurse from their professional responsibilities towards their clients and patients and, in some cases, should be declined, for example where a veterinary surgeon or veterinary nurse would not otherwise enter into that arrangement.

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1.9 Veterinary surgeons and veterinary nurses considering accepting any form of incentive should carefully consider whether the incentive should be disclosed to their client. The decision to disclose should take into account all relevant factors, including the value of the incentive, the expectations of the client, any practical issues, and the likely implications should the existence of the incentive not be disclosed but is discovered at a later date. The more likely the perception of bias or improper influence, the more readily veterinary surgeons and veterinary nurses should make disclosures to clients.

Referring a case

1.10 The initial contact should be made by the referring veterinary surgeon, and the referral veterinary surgeon should be asked to arrange the appointment.

1.11 The referring veterinary surgeon should provide the referral veterinary surgeon with the case history and any relevant laboratory results, radiographs, scans etc. Any further information that may be requested should be supplied promptly.

1.12 The referral veterinary surgeon should discuss the case with the client including the likely costs of the referral work and promptly report back on the case to the primary veterinary surgeon. When reporting back to the referring veterinary surgeon, there should be transparency as to who dealt with the case.

Second opinions

1.13 Veterinary surgeons may follow similar procedures for second opinions and should ensure that any differences of opinion between the veterinary surgeons are discussed and explained constructively.

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Date 27 April 2016

Title Directing prescriptions


Summary At its previous meeting in January 2016 the Committee discussed whether it is acceptable for veterinary surgeons to direct written prescriptions to specific (i.e. named) online pharmacies. It was agreed that further consideration of the matter would be well-informed by having views from the Competition and Markets Authority and the Veterinary Medicines Directorate.

Decisions required To decide whether or not the College should accept the directing of written prescriptions by veterinary surgeons. The Committee is asked to consider whether additions to the supporting guidance are required in this regard.

Attachments Annex A: Views of the BVA Annex B: Views of the BSAVA Annex C: Example amendment to chapter 10 of the supporting guidance

Author Rebecca Rafferty

Senior Advice Officer (Solicitor)

020 7227 3503

[email protected]

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Directing prescriptions

Background

1. At its previous meeting in January 2016 the Committee discussed whether it is acceptable for veterinary surgeons to direct written prescriptions to specific (i.e. named) online pharmacies. This issue was brought to the attention of the College by a representative of an online pharmacy who provided real examples to demonstrate that this is already happening. The representative advised that this behaviour is actively discouraged in the human healthcare setting.

2. In the first instance, the Advice Team considered that this behaviour may be tantamount to endorsement, contrary to the supporting guidance at chapter 23 (‘advertising and publicity.’)

3. There were mixed views within the Committee on the appropriateness or otherwise of veterinary surgeons making specific directions to online pharmacies on their written prescriptions.

4. Some members considered that the issue cannot be considered in isolation, recognising that veterinary surgeons make directions and recommendations every day, whether it be the recommendation of a particular farrier, direction to a referral centre or the prescription of a specific medicinal product. With this in mind, why should we treat the direction of prescriptions to a particular retailer any differently?

5. On the other hand, some members felt strongly that the direction of prescriptions is inappropriate.

The very reason for making prescriptions available to clients is to allow them choice as to where they source their veterinary medicines. It was considered that to permit veterinary surgeons to direct prescriptions is to undermine this principle.

6. It was agreed that further consideration of the matter would be well-informed by having views from the Competition and Markets Authority and the Veterinary Medicines Directorate.

The Competition and Markets Authority (CMA) 7. The CMA was asked to give a view on the issue, given their interest in the fair trading

requirements, which were agreed between the College and the CMA’s predecessor – the Office of Fair Trading. The CMA responded as follows:

This issue does not relate to the Order or the wider set of remedies arising from the CC’s [Competition Commission] report into veterinary medicines. It may be more of a Competition Act 1998 (Chapter 1) matter or a practice caught by Article 101 of the Treaty on the Functioning of the European Union if it could be shown that there was an effect on trade between member states. Agreements between a vet and a pharmacy that the pharmacy would pay fees to a vet in return for the vet endorsing or recommending the pharmacy could cause some foreclosure of the market to competing pharmacies, depending on how much notice consumers take of a recommendation to use a particular pharmacy, and they would probably take quite a lot of notice. On the other hand, one can argue it is good for vets to advertise the fact that consumers can go to a pharmacy for their veterinary medicines rather than buy them from the vet.

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Although it is far from clear whether competition legislation would apply to this endorsement issue we share your RCVS’s discomfort about vets endorsing pharmacies, especially in the situation where the endorsement is given in return for some kind of payment in cash or in kind.

The Veterinary Medicines Directorate (VMD) 8. The VMD was asked if they could do anything to support a decision by the College to discourage

the direction of written prescriptions, specifically whether VMD guidance could reflect this. We also asked if the VMD could go further by way of relevant stipulations regarding written prescriptions. The VMD responded as follows:

Whilst we don’t endorse vets directing their clients to send their prescriptions to specific retailers (which includes veterinary practice premises as well as pharmacies), we’re unable to stipulate any additional directions on a prescription without amending the Veterinary Medicines Regulations. In the current agenda of deregulation, that would be very unlikely. Furthermore, as the review of the EU legislation is now fairly well developed, it would also be very unlikely that any additional requirements could be included in relation to the content of a written prescription. Therefore, we remain of the view that this is a professional matter and therefore one for the RCVS to pronounce on.

The British Veterinary Association (BVA) and British Small Animal Veterinary Association (BSAVA) 9. We have also approached the BVA to ask for their views on the matter. Their response is

attached at Annex A. The BSAVA also provided their views and these are attached at Annex B.

10. Both the BVA and BSAVA advised that we must recognise that there are many situations where a veterinary surgeon may advise or recommend a service to a client based on knowledge and experience of that service. They also added that there may be a case for a veterinary surgeon to direct a client to a particular pharmacy in the case where a medicine has been specifically ordered in for a particular patient. This should be done as a means of providing the appropriate medication in a timely manner rather than restricting client choice.

11. They did, however, raise concerns about endorsement and limited client choice where a financial

incentive or kickback was involved but otherwise made the point that veterinary surgeons make a wide range of decisions on behalf of clients and that some of these e.g. drugs stocked and services provided (e.g. cremation services) are based on business decisions and theoretically limit client choice.

Next steps

12. The Committee is asked to decide whether or not the College should accept the directing of written prescriptions by veterinary surgeons.

13. While the Committee may note the comments regarding endorsement, they may prefer to consider the matter as one of veterinary surgeons making recommendations; the concerns therefore being the basis of those recommendations and the extent to which client choice is preserved. If that is

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the case, the Committee may consider that the directing of written prescriptions can be accepted in certain circumstances and with some form of control.

14. Whatever decision they come to, the Committee is asked to consider additions to the supporting

guidance to clarify the position. A logical place for such guidance might be chapter 10, as this is the fair trading guidance. We may have to seek approval from the CMA to any additions to this chapter of guidance.

15. An example amendment is shown at Annex C for illustrative purposes only and is not intended to

force the Committee to make a particular decision.

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SC Apr 16 AI 03(b) Annex A

Rebecca Rafferty Senior Advice Officer Royal College of Veterinary Surgeons Belgravia House 62-64 Horseferry Road London SW1P 2AF [by email: [email protected]]

Thursday 31 March 2016

Directed prescriptions Thank you for your email of 17 March 2016 requesting on the matter of the direction of prescriptions. BVA Medicines group had not previously considered the matter, which had arisen following a discussion by the RCVS Standards Committee. In their discussions they made the following comments: Directed prescriptions and the veterinary profession

• The situation in the veterinary field differs from the medical profession because veterinary practices are generally able to dispense medication and consequently the number of clients asking for prescriptions is low. BSAVA and PVS raised the point that veterinary clients shopping for prescriptions are more likely to make decisions based on price rather than convenience; the price of NHS prescriptions is standard but there may be differences in terms of service and/or delivery.

• The veterinary profession does not have an electronic prescription service and therefore pharmacies are not competing for veterinary practice business.

• BSAVA noted that most clients requesting a prescription will have a pharmacy (most

likely online) in mind for supply of the medication. Some online pharmacies even provide a downloadable prescription template https://www.vetuk.co.uk/VetUK-Prescription-form.pdf . The exception to this may be where a veterinary surgeon prescribes a human medicine for a pet in which case the vet may have contacted a local pharmacy in advance to see if they have the product in stock or had it specially ordered. This should be done as a means of providing the appropriate medication in a timely manner rather than restricting client choice, but any advice from the RCVS should allow for this type of situation.

• A number of members were concerned about unscrupulous online pharmacies and felt that when providing a prescription, vets should provide information on approved

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local premises or a link to VMD-approved online retailers would be of benefit to the client.

Acceptability of directed prescriptions

• Members felt this was primarily an issue for prescriptions for pets and companion animals. The Pig Veterinary Society noted that bulk price of feed was the key driver behind where the prescription was filled.

• Overall members were not opposed to the direction of prescriptions and did not feel the behaviour realistically limited the choice of the client although it had the potential to do so. However, members did oppose the behaviour in the event of there being a kick-back or financial incentive involved, which could be seen as endorsement of a particular business/ product, contrary to chapter 23 of the RCVS supporting guidance, and detrimental to client choice.

• BSAVA noted that whilst these principles appeared straightforward, veterinary

surgeons do receive financial incentives from major suppliers (e.g. veterinary wholesalers and pharmaceutical companies) in terms of discounts for volume of product purchased and that veterinary practices regularly make choices for clients – e.g. In the brand of vaccines or antimicrobials that are stocked and used in the practice.

Frequency of directed prescribing within the profession

• Members were aware of specific prescribing – electing to preferentially prescribe one product over another. When writing prescriptions veterinary surgeons are required to prescribe a specific authorised medicine, or if no authorised medicine follow the cascade in their choice of product. This amounts to a specific direction of the product (brand to be dispensed) although we have anecdotal reports that there are many instances of pharmacies failing to follow this direction.

• Medicines group members were not aware of directing of prescriptions taking place within their diverse sectors.

• A future consideration is that directing of prescriptions may arise if an insurance company directs their client to get their prescription from a particular pharmacy (as part of the policy terms and conditions) in order to control costs.

In conclusion, BVA does not support the directing of prescriptions in a specific manner. Veterinary prescriptions should be evidence-based, transparent, and not incentivised in any way. Whilst a veterinary surgeon should not prevent a client from using the pharmacy (or other service) of their choice through a directed prescription that can only be used in one place we recognise that there are many situations where a veterinary surgeon may advise or recommend a service based on knowledge and experience of the service that they can provide. Best regards,

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https://www.gov.uk/government/publications/accredited-internet-retailer-scheme-airs

John Blackwell, BVA Senior Vice President

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SC Apr 16 AI 03(b) Annex B

Directed prescription – Comments from BSAVA We have been asked to comment on the practice of “Direction of prescriptions”, this request initially come through BVA Medicines group, but discussions with the RCVS have indicated that this is part of a larger review of incentives that is being carried by the RCVS Standards Committee, and they are happy for us to feed into them directly. The initial request from BVA stated that “RCVS is seeking input from BVA on the direction of prescriptions – essentially where a written veterinary prescription includes a specific suggestion that clients buy their medicines from a named pharmacy (often an online pharmacy).” And stated that There are concerns that this practice restricts client freedom of choice and that this is discouraged in the human field – see the attached from NHS England and the poster that is to be displayed in GP surgeries and pharmacies. The situation in the veterinary field is somewhat different to that in the NHS because

• The majority of Veterinary Practices are able to dispense medication • The number of clients asking for prescriptions is generally low • Veterinary clients shopping for prescriptions are more likely to be shopping on price rather

than convenience (With NHS prescriptions the price will be the same but there may be differences in terms of service / delivery etc)

• We do not have an Electronic Prescription Service – so Pharmacies are not competing for Veterinary Practice Business

In Veterinary Practice it is more likely that the request for a prescription will come from the client and that they will already have a pharmacy (most likely online) in mind for supply of the medication. Some online pharmacies even provide a downloadable prescription template https://www.vetuk.co.uk/VetUK-Prescription-form.pdf . The exception to this may be where a veterinary surgeon prescribes a human medicine for a pet in which case they may have contacted a local pharmacy in advance to see if they have the product in stock. There may also be situations in which a third party- e.g. insurance company directs their client to get their prescription from a particular pharmacy. Questions

• Do medicines group feel this activity affects client choice as to where they source medicines?

We accept that clients should have choice in where they source prescribed medicines. If a veterinary surgeon were asked to provide a prescription and provided a prescription for a particular pharmacy or chain of pharmacies we can see that this could potentially restrict client choice. Currently we are not aware that veterinary surgeons in practice are directing clients to use particular pharmacies, however if they are providing a prescription it would be appropriate to inform the client that if they are using an on-line pharmacy that it should be one that is registered with the VMD Accredited Retailer Scheme https://www.gov.uk/government/publications/accredited-internet-retailer-scheme-airs , and to avoid those internet pharmacies that are outside of the UK. With the proposed amendments to the Veterinary Medicines Regulations to encourage intra-community trade in pharmaceuticals this may become more difficult / complex in future.

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https://www.vetuk.co.uk/VetUK-Prescription-form.pdf




We would have concerns that the use of downloadable prescription forms from an internet pharmacy may be open to abuse and prescription fraud and would suggest that Veterinary Surgeons use practice headed paper or BVA prescription pads rather than completing a form presented by the client or third party. This would enable the client to present the prescription to any pharmacy and increase rather than decrease client choice. However, there may be a case for a veterinary surgeon to direct a client to a particular pharmacy in the case where a medicine has been specifically ordered in for a particular patient. This should be done as a means of providing the appropriate medication in a timely manner rather than restricting client choice, but any advice from the RCVS should allow for this type of situation.

• Would your view on this change if the vet had a financial incentive or ‘kickback’ that encouraged them to direct prescriptions?

In general we would think that the receipt of a financial incentive for directing clients to a particular pharmacy could be seen both of endorsement of a particular business/ product, contrary to chapter 23 of the RCVS supporting guidance (Endorsement and Claims of general veterinary approval), and detrimental to client choice. However, there while these principles may appear straightforward in these circumstances it should be remembered that veterinary surgeons do receive financial incentives from major suppliers (e.g. veterinary wholesalers and pharmaceutical companies) in terms of discounts for volume of product purchased and that veterinary practices regularly make choices for clients – e.g. In the brand of vaccines or antibacterials that are stocked and used in the practice. We are also aware that certain referral centres provide free CPD to those practices which refer to them.

• Are you aware of this activity within your sector and/or personal experience? We are not aware of individual veterinary surgeons / veterinary practices directing clients to specific pharmacies or receiving payment for this, but see comments above. However, when writing prescriptions veterinary surgeons are required to prescribe a specific authorised medicine, or if no authorised medicine follow the cascade in their choice of product. This amounts to a specific direction of the product (brand to be dispensed) although we have anecdotal reports that there are many instances of pharmacies failing to follow this direction.

• Do you feel this activity is acceptable or not? Why? In general we would consider that veterinary surgeons should be making recommendations to their client based on welfare of the animal patient and the circumstances of the client and not based on financial incentives from third party. That said we are also aware that veterinary surgeons make a wide range of decisions on behalf of clients and that some of these e.g. Drugs stocked and services provided (e.g. cremation services) are based on business decisions and theoretically limit client choice. Therefore while we do not think that a veterinary surgeon should prevent a client from using the pharmacy (or other service) of their choice through a directed prescription that can only be used in one place we recognise that there are many situations where a veterinary surgeon may advice or

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http://www.rcvs.org.uk/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/advertising-and-publicity/

http://www.rcvs.org.uk/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/advertising-and-publicity/


recommend a service based on knowledge and experience of the service that they can provide. While the veterinary surgeon should not base this advice on financial or other incentives that they receive we acknowledge that in a business environment, financial incentives to good customers in terms of discounts or other benefits are common place and need to be recognised.

• Do you have any other comments? The comments included here relate primarily to individual veterinary surgeons / practices. However we are also aware that the environment of veterinary practice is changing with “corporate” groups owning not only veterinary practices but also providing ancillary services such as laboratories, cremation and online pharmacy (http://www.cvsukltd.co.uk/ http://www.petsathome.com/shop/en/pets/content/vets?cm_re=Homepage-_-Service2-_-VETS-_-) . In these cases making the relationships explicit and minimising the impact on client choice will be more of a challenge.

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http://www.cvsukltd.co.uk/

http://www.petsathome.com/shop/en/pets/content/vets?cm_re=Homepage-_-Service2-_-VETS-_-

http://www.petsathome.com/shop/en/pets/content/vets?cm_re=Homepage-_-Service2-_-VETS-_-

SC Apr 16 AI 03(b) Annex C

10. Fair trading requirements Existing guidance in grey/blue New guidance in red

Introduction

10.1 These responsibilities were agreed between the RCVS and the Office of Fair Trading as an alternative to legislation under the Fair Trading Act, to ensure that clients have access to sufficient information to be able to decide where to obtain veterinary prescriptions and medicines.

10.2 Veterinary surgeons must:

a. ensure clients are able to obtain prescriptions, as appropriate. (A veterinary surgeon may prescribe a medicine of category Prescription Only Medicine, Veterinarian (POM-V), only following a clinical assessment of an animal under his or her care; a prescription may not be appropriate if the animal is an in-patient or immediate treatment is necessary);

b. not prevent a client from using the pharmacy (or other service) of their choice and should ensure that any advice or recommendations given to clients in this regard are guided by considerations of knowledge and experience of the service;

c. subject to any legal restrictions, ensure there is adequate provision of information on medicine prices;

d. provide the price of any relevant veterinary medicinal product stocked or sold, to clients, or other legitimate enquirers, making reasonable requests;

e. if requested, inform clients of the price of any medicine to be prescribed or dispensed; f. where possible and relevant, inform clients of the frequency of, and charges for, further

examinations of animals requiring repeat prescriptions; g. provide clients with an invoice that distinguishes the price of relevant veterinary medicinal

products from other charges and, where practicable, provide clients with an invoice that distinguishes the price of individual relevant veterinary medicinal products;

h. advise clients, by means of a large and prominently displayed sign, or signs, (in the waiting room or other appropriate area), with reference to the following:

"Prescriptions are available from this practice. You may obtain relevant veterinary medicinal products from your veterinary surgeon OR ask for a prescription and obtain these medicines from another veterinary surgeon or a pharmacy. Your veterinary surgeon may prescribe relevant veterinary medicinal products only following a clinical assessment of an animal under his or her care. A prescription may not be appropriate if your animal is an in-patient or immediate treatment is necessary. You will be informed, on request, of the price of any medicine that may be prescribed for your animal. The general policy of this practice is to re-assess an animal requiring repeat prescriptions for/supplies of relevant veterinary medicinal products every XX months, but this may vary with individual circumstances. The standard charge for a re-examination is £XX. Further information on the prices of medicines is available on request."

i. provide new clients with a written version of the information set out in the sign, or signs, referred to in paragraph 10.2(g), which may be set out in a practice leaflet or client letter;

j. on a continuing basis, take reasonable steps to ensure that all clients are provided with a written version of the information set out in the sign, or signs, referred to in paragraph 10.2(g), which may be set out in a practice leaflet or client letter.

10.3 A reasonable charge may be made for written prescriptions; such prescriptions for POM-V medicines may be issued only for animals under the care of the prescribing veterinary surgeon and following his or her clinical assessment of the animals.

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SC Apr 16 AI 03(b) Annex C

10.4 A veterinary surgeon must not discriminate between clients who are supplied with a prescription and those who are not, in relation to fees charged for other goods or services.

Note: ‘Relevant veterinary medicinal product‘ has the same meaning as in The Supply of Relevant Veterinary Medicinal Products Order 2005; in brief, these are medicines of category POM-V, excluding medicated feeding stuffs.

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SC Apr 16 AI 03(c)


Date 27 April 2016

Title Review of the 12 Principles of Certification


Summary This paper provides an update on the Certification Sub-Committee Review of the 12 Principles of Certification and Supporting Guidance.

Decisions required Standards Committee is asked to:

a. Consider and approve the revised 12 Principles (now 10) and Supporting Guidance as recommended by the Certification Sub-Committee;

b. Decide on how to progress discussions on the future

concept of veterinary nurses and certification; and c. Endorse additional work to refresh and update the guidance

on veterinary surgeons giving evidence for Court, with input from the Sub-Committee and RSPCA, as appropriate.

Attachments Annex A: Current certification guidance (Chapter 21)

Annex B: FVE 10 Principles of Certification

Annex C: Revised Principles (now 10) and certification guidance

Annex D: Wooler recommendations relating to the gathering and presentation of veterinary evidence and the RSPCA response

Annex E: Current guidance for veterinary surgeons giving evidence for Court.

Authors Laura McClintock Standards and Advisory Manager/ Solicitor 0207 202 0763 [email protected]

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Review of the 12 Principles of Certification Background: the consultation process

1. Standards Committee is aware that the Certification Sub-Committee has been carrying out a review of the current 12 Principles of Certification and associated Supporting Guidance on Certification. The guidance has been in place for a number of years and required a substantial review to ensure it remains fit for purpose. Additionally, the Sub-Committee has, in recent years, seen an increased number of enquiries relating to certification in other areas such as remote certification and electronic certification, which may require additional guidance. A copy of the current guidance is attached at Annex A.

2. In 1998 the Federation of Veterinarians of Europe (FVE) developed a position paper outlining the main principles of veterinary certification (FVE/98/053). Now, more than 15 years later, they have revised and updated the original document and the FVE Veterinary Statutory Body Working Group has since recommended 10 Principles of Veterinary Certification. A copy of the FVE 10 Principles is attached at Annex B.

3. As part of the review, the Sub-Committee invited 29 individual organisations to respond to the

consultation. The consultation papers were also publicised on the websites of other major stakeholder organisations. Potential responders were asked to comment on the 12 Principles and guidance generally as well as on the FVE 10 Principles (specifically whether these were considered appropriate for the UK veterinary sector). A representative from VN Council was also invited to attend Sub-Committee meetings in order to consider the concept of veterinary nurses and certification and where this might go in the future.

4. The Sub-Committee received good quality feedback on the consultation. Written submissions were

received from those such as the BVA (and sub divisions), UK government departments, the Veterinary Defence Society as well as a number of other organisations involved in certification work, including Dairy UK, the International Meat Trade Organisation, UK Delivery Partners for government veterinary services and the Society of Greyhound Veterinarians.

5. Overall, the consultation process demonstrated that there is a need to review and update the 12

principles; however, the responses from the profession, industry and government indicate that a radical transformation is not required. It is clear that many of the principles remain relevant today although some revision to reflect modern certification practice is required.

Revisions to the current guidance 6. The Certification Sub-Committee has met on a number of occasions to consider the consultation

responses and to work on revising and modernising the current guidance. Minutes of those discussions have been reported to Standards Committee previously.

7. A first draft of revised guidance has now been produced and is attached at Annex C. In summary, the key changes are as follows:

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SC Apr 16 AI 03(c)


a. A refreshed format and improved structure for the guidance. This includes more detailed opening paragraphs and more positive statements about the role of the veterinary surgeon in certification. The Sub Committee – and a number of responders – felt that the previous guidance had a negative feel. Maintaining the integrity of certification is still covered in the revised guidance, but it is hoped that the overall tone of the guidance is improved.

b. The 12 Principles have been reduced to the 10 Principles of Certification. Each Principle is followed by a section of relevant supporting guidance.

c. Original Principle 2 (i.e. neither a veterinarian nor any person described in Principle 1 should be

requested or required to sign anything relating to matters which cannot be verified by the signatory) has been removed. This was considered unnecessary and it was felt that it was aimed at the person/organisation asking the veterinary surgeon to certify.

d. Original Principle 10 (i.e. where appropriate, notes for guidance should be provided to the

certifying veterinarian by the issuing authority indicating the extent of the enquiries he is expected to make, the examinations he is required to carry out, or to clarify any details of the certificate which may require further interpretation) has been moved to the Supporting Guidance. This was considered more in the realms of advice as opposed to a fundamental principle.

e. The new RCVS 10 Principles are not identical to the FVE 10 Principles. Both sets of 10

Principles are similar, but there are some minor differences. In some cases, we have mirrored FVE wording exactly and in other cases we have adopted our own wording. We have not adopted FVE wording that we consider to be repetitive or irrelevant.

f. FVE Principle 2 (i.e. veterinarians should not issue a certificate which might raise questions of a

possible conflict of interest) and FVE Principle 3 (i.e. veterinarians must not allow commercial, financial or other pressures to compromise their impartiality) were considered to cover the same points. We have retained our own equivalent of FVE Principle 2 and included FVE Principle 3 in our supporting guidance only.

g. New RCVS Principle 4 (i.e. that a veterinarian should not certify that there has been compliance

with the law of another country or jurisdiction unless the provisions of that law are set out clearly on the certificate or have been provided to them by the Competent Authority in writing) has not been retained in the FVE Principles.

h. New guidance on official certification for export of live animals and animal products, including

reminders on the importance of complying with official Notes for Guidance or advice from the Competent Authority.

i. New guidance on the recognition of the role of paraprofessionals in assisting official

certification, for example, advice on the use of trained official auxiliaries as permitted by some EU certification regulations.

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j. New guidance on remote certification and when this might be appropriate, specifically the certification of low risk products based on knowledge of the processing plants and working procedures.

k. Updated guidance on electronic certification, including the use of electronic signatures.

l. New guidance on the need for appropriate retention and storage of certificates.

8. Standards Committee is asked to consider and approve the revised 12 Principles and Supporting

Guidance. Other matters arising from the review (a) Veterinary nurses and certification

9. The Sub-Committee also discussed the concept of certification by veterinary nurses and where this

might go in the future. It was noted that as veterinary nurses are now recognised as a profession it is likely that their involvement in certification might potentially be extended in the future.

10. The Sub-Committee felt that, in theory, the Principles of Certification could potentially apply to veterinary nurses in the future. However, veterinary nurses are not currently involved in this area of work and do not receive specific training in certification so this is another area that may need further consideration from an education perspective. Additionally, in order for veterinary nurse certification to be acceptable in the context of government work for example there would need to be acceptance by the Competent Authority.

11. The Sub-Committee agreed that this is an area for wider consideration by the Standards

Committee in due course. One suggestion would be to include the issue of veterinary nurse certification in the ongoing general review of veterinary nurse activities and Schedule 3.

(b) Veterinary certification in the context of the Animal Welfare Act

12. The Sub-Committee also considered a number of issues relating to veterinary certification under

the Animal Welfare Act. In 2013 the RSPCA commissioned an independent review of its prosecution activity. The review was conducted by Mr Stephen Wooler CB (former Chief Inspector of HM Crown Prosecution Service Inspectorate) and contained 33 recommendations suggesting how the RSPCA could improve its enforcement processes. There were a number of recommendations (5 in total) relating to the gathering and presentation of veterinary evidence. These are attached at Annex D, alongside the RSPCA response. The following recommendations were particularly relevant to the Sub Committee’s discussions on certification:

• Recommendation 22 relates specifically to veterinary surgeons’ professional responsibilities when certifying under Section 18 of the Animal Welfare Act (Powers in relation to animals in distress). To explain briefly, a veterinary certificate is required before animals can be seized under this provision. The veterinary surgeon must be satisfied that the animal is suffering or likely to suffer if its circumstances do not change.

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The report indicated that there have been some cases where a certificate has been issued over the telephone or otherwise on the basis of a telephone conversation with an Inspector. As the legal basis for this is not clear, Stephen Wooler recommended that “Inspectors should be formally instructed not to seek certification by a veterinary surgeon under section 18 of the Animal Welfare Act 2006 unless the vet has examined the animal(s) in question”. This has been accepted by the RSPCA. Stephen Wooler’s recommendation already correlates with the longstanding advice of the Sub Committee which is that in the vast majority of cases a telephone call would be insufficient evidence to provide an authority such as the Police with any form of veterinary certification. Veterinary surgeons should only provide such certification if they can examine or assess the animal in question. The report did not say how prevalent the issue of telephone certification was considered to be and the RCVS was not aware of these issues. The RSPCA has offered to produce guidance for veterinary surgeons providing certification under Section 18, but the Sub-Committee considers this is a matter for the RCVS and not the RSPCA. Any guidance should also cover the equivalent provisions in the Animal Health and Welfare (Scotland) Act 2006 and the Welfare of Animals (Northern Ireland) Act 2011.

• Recommendation 23 relates to the definition of suffering. Stephen Wooler recommended

that the RSPCA should take the lead in inviting the RCVS and other practitioners to develop a common standard or guidance on the approach to assessment of suffering. The RSPCA has indicated that defining suffering for court proceedings is challenging and, after consultation with lawyers and veterinary surgeons, it has been agreed that it is appropriate to rely on the Oxford English Dictionary definition. We understand from the RSPCA that work on an approach to suffering is a longer term aim, and will require more research and collaboration. The Sub-Committee had no objection to this approach.

• Recommendation 24 relates to the use of veterinary surgeons as experts. Stephen Wooler

recommended that “the RSPCA should establish a panel of accredited veterinary practitioners (with known specialisms where practicable) to be drawn upon by inspectors requiring examination of case animals. Vets on the panel should be expected to work within a fee structure and to a service level agreed with the RSPCA”. While decisions relating to RSPCA panels or funding are not for the RCVS, we do have a responsibility to ensure veterinary surgeons involved in giving evidence at Court are aware of their professional and legal responsibilities, particularly if they are appearing as a professional and/or expert witness. The RCVS already provides guidance for veterinary surgeons giving evidence for Court (attached at Annex D). This has been in place for a number of years. Indeed, Stephen Wooler indicated that the substance of our guidance remains valid although it may be helpful to include additional information relating to criminal proceedings.

23. Overall, the Su-Committee encourages Standards Committee to endorse additional work to refresh and update the guidance on veterinary surgeons giving evidence for Court, with input from the Sub-Committee and RSPCA, as appropriate.

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SC Apr 16 AI 03(c) Annex A

21. Certification (Current guidance) Updated 12 April 2012

Introduction 21.1 The simple act of signing their names on documents has a great potential for error for veterinary surgeons. A certificate is a "written statement made with authority", the authority in this case coming from the veterinary surgeon's professional status.

The 12 Principles of Certification

1. A veterinarian should be asked to certify only those matters which are within his own knowledge, can be ascertained by him personally or are the subject of a supporting certificate from another veterinarian who does have personal knowledge of the matters in question and is authorised to provide such a supporting document. Matters not within the knowledge of a veterinarian and not the subject of such a supporting certificate but known to other persons, eg the farmer, the breeder or the truck driver, should be the subject of a declaration by those persons only. 2. Neither a veterinarian nor any person described in Principle 1 above should be requested or required to sign anything relating to matters which cannot be verified by the signatory. 3. Veterinarians should not issue a certificate which might raise questions of a possible conflict of interest eg in relation to their own animals. 4. All certificates should be written in terms which are as simple and easy to understand as possible. 5. Certificates should not use words or phrases which are capable of more than one interpretation. 6. Certificates should be: a. produced on one sheet of paper or, where more than one page is required, in such a form that any two or more pages are part of an integrated whole and indivisible; b. given a unique number, with records being retained by the issuing authority of the persons to whom certificates bearing particular numbers were supplied. 7. Certificates should be written in the language of the veterinarian signing them, and accompanied by an official translation of the certificate into a language of the country of ultimate destination. 8. Certificates should identify animals individually except in cases where this is impractical, eg day old chicks. 9. Certificates should not require a veterinarian to certify that there has been compliance with the law of the European Union or a third country unless the provisions of the law are set out clearly on the certificate or have been provided to him by the issuing authority. 10. Where appropriate, notes for guidance should be provided to the certifying veterinarian by the issuing authority indicating the extent of the enquiries he is expected to make, the examinations he is required to carry out, or to clarify any details of the certificate which may require further interpretation. 11. Certificates should always be issued and presented in the original. Photocopies are not acceptable. Provided that: a. a copy of the certificate (clearly marked 'COPY') should always be provided to the authority by whom the certificates were issued - see Principle 6 above; and b. where, for any good and sufficient reason (such as damage in transit) a duplicate certificate is authorised and supplied by the issuing authority, this must be clearly marked 'duplicate' before issue.

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12. When signing a certificate, a veterinarian should ensure that: a. he signs, stamps and completes any manuscript portions in a colour of ink which does not readily photocopy, ie a colour other than black; b. the certificate contains no deletions or alterations, other than those which are indicated on the face of the certificate to be permissible, and subject to such changes being initialled and stamped by the certifying veterinarian; c. the certificate bears not only his signature but also, in clear lettering, his name, qualifications and address and (where appropriate) his official or practice stamps; d. the certificate bears the date on which the certificate was signed and issued and (where appropriate) the time for which the certificate will remain valid; e. no portion of the certificate is left blank, so that it could subsequently be completed by some person other than the certifying veterinarian.

General principles of certification 21.2 The 12 Principles of Certification were drafted by the RCVS, the British Veterinary Association and the Ministry of Agriculture, Fisheries and Food (now the Department for the Environment, Food and Rural Affairs [Defra]) and adopted by the Federation of Veterinarians of Europe. Eight of the 12 principles are included in the EU Directive 96/93/EC. Their purpose is to provide the foundation of certification for all those who draft or prepare, use or sign veterinary certificates even though at the present time veterinary surgeons may be presented with certificates which do not conform to all of them.

21.3 In framing obligations which veterinary surgeons must fulfil under day-to-day working conditions, the RCVS has taken into account not only the 12 Principles of Certification but also relevant UK law including the Trade Descriptions Act 1968 (as amended) which specifies the defences open to the signatory of a certificate or equivalent document if he or she is challenged, and also the fact that veterinary surgeons may be presented with certificates which do not conform to all of the 12 principles.

21.4 Given that veterinary surgeons' professional reputations and livelihoods may be at stake if their signatures on certificates are open to challenge, and that they may be presented with certificates that do not conform to all of the 12 Principles of Certification, the RCVS strongly advises veterinary surgeons as follows:

a. CAUTION Before signing any certificate veterinary surgeons must: i. scrutinise the document, whatever its title ii. be clear as to whom they are responsible in exercising their authority when they sign the

document

b. CLARITY Scrutinising the document includes: i. reading and understanding any explanatory supporting material; ii. checking carefully for any ambiguity which should be clarified with whoever has issued the

certificate;

iii. in the case of certificates relating to international or European Economic Area trade, veterinary surgeons may need to ask Defra's assistance. They should record in writing the information received, the date and time it is received and the name of the Defra official giving the advice. They should expect their own queries to be similarly recorded. They may request and expect to receive written confirmation of the guidance given to them.

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c. CERTAINTY In considering what they will attest in order to satisfy the obligation of certainty, veterinary surgeons:

i. must be sure that they attest only to what to the best of their knowledge and belief is true; ii. do not attest to future events; iii. do not recklessly attest to what others have declared or asserted; iv. may attest to what another veterinary surgeon has certified. They may also attest to the fact that

a declaration or assertion has been made by another person without attesting to its validity.

d. CHALLENGE If they have gone further in what they have attested, they must consider what their defence would be if challenged, and keep appropriate written records made at the time of the decision to sign. For example, if challenged under the Animal Health Act 1981 (as amended) with false certification could they show (in the words of that Act):

i. that he did not know of that falsity and that he could not with reasonable diligence have obtained knowledge of it or, if challenged under the Trade Descriptions Act 1968 (as amended) could they show (in the words of that Act):

ii. that the commission of the offence was due to a mistake or to reliance on information supplied to him or to the act or default of another person, an accident or some other cause beyond his control; and

iii. that he took all reasonable precautions and exercised all due diligence to avoid the commission of such an offence by himself or any person under his control.

21.5 Some documents (for example, forms, declarations, insurance claims, witness statements and self-certification documents) may involve the same level of responsibility even if they do not bear the name of ‘certificate’. If the facts are incorrect or misleading, the professional integrity of the veterinary surgeon is called into question. Cases coming before the Disciplinary Committee may arise from allegations of false certification.

21.6 There are three hazards for the veterinary surgeon when ’certifying‘ in the wider sense:

a. Negligence: a breach of the duty owed to a relevant party with consequent damage. Negligence may arise from a failure to disclose all of the material facts or supplying incorrect information. The consequence may be civil court proceedings.

b. Criminal offences: criminal offences may be committed under trade descriptions legislation, legislation controlling animal exports and by aiding and abetting a third party. They may include fraud, or knowingly or recklessly supplying false information. Any conviction brought to the notice of the RCVS may be considered in relation to the fitness of the veterinary surgeon to practise.

c. Professional misconduct: even if no criminal charges are brought, an aggrieved party or enforcement authority may make a formal complaint to the RCVS. If the complaint is judged to be justified, penalties may follow.

Electronic certification 21.7 The RCVS considers electronic veterinary certificates are acceptable, subject to sufficient safeguards and security. An example of a system that has been accepted by the RCVS is TRACES (Trade Control and Expert System), an EU-wide electronic certification and notification system that is being phased in for the provision of export health certificates and supporting documents for intra-Community trade in certain circumstances; and currently used by DEFRA.

Additional matters 21.8 Veterinary surgeons may be asked to attest ‘to the best of their knowledge and belief’. In these circumstances, veterinary surgeons should exercise caution and attest only to what to the best of their

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knowledge and belief is true. They should not attest to future events; or recklessly attest to what others have declared or asserted, without giving any apparent thought to the ’Four Cs’ outlined above in paragraph 21.4.

21.9 All parts of a certificate or its equivalent should bear the date of the examination or test carried out, vaccination or sample taken, the date of signing the certificate and the name and address of the signatory veterinary surgeon.

21.10 Mistakes on forms/certificates can occur; occasionally, these may be inadvertent. Such mistakes should be rectified as soon as they are identified.

21.11 A veterinary surgeon who acts in an official capacity should only use any official stamp issued to him on official certificates issued or approved by Defra.

Identification of animals 21.12 If an alleged identification mark is not legible at the time of inspection, no certificate should be issued until the animal has been re-marked or otherwise adequately identified. 21.13 When there is no identification mark, the use of the animal's name alone is inadequate. If possible, the identification should be made more certain by the owner inserting a declaration identifying the animal, so that the veterinary surgeon can refer to it as 'as described'. Age, colour, sex, marking and breed may also be used.

21.14 The owner's name must always be inserted. (In the case, for example, of litters of unsold puppies this will be the name of the breeder or the seller.)

21.15 Where microchipping or tattooing has been applied it should be referred to in any certificate of identification.

Official certification for export of live animals and animal products and casualty slaughter certificates 21.16 Guidance is issued by Defra for the completion of these certificates and should be scrupulously followed. When problems are identified, the Animal Health and Veterinary Laboratories Agency should be consulted and, if not then resolved, the advice of the RCVS should be sought.

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President

Christophe Buhot

Vice-Presidents

Hans-Joachim Götz

Robert Huey Rafael Laguens

Karin Östensson

Members

Austria

Belgium

Bosnia-Herzegovina Bulgaria

Croatia

Cyprus Czech Republic

Denmark

Estonia Finland

France

FYROM Germany

Greece

Hungary Iceland

Ireland

Italy Latvia

Lithuania

Luxembourg Malta

Montenegro

Netherlands Norway

Poland Portugal

Romania

Serbia Slovak Republic

Slovenia

Spain Sweden

Switzerland

Turkey United Kingdom

Observers

Albania

Ukraine

Sections

UEVP

Practitioners

EASVO

State Officers

UEVH

Hygienists

EVERI

Veterinarians in

Education, Research

and Industry

FEDERATION OF VETERINARIANS OF EUROPE

Federation of Veterinarians of Europe AISBL

12 Avenue de Tervueren, 1040 Brussels

Tel: +32.2.533.70.20 - E-mail: [email protected] - Internet: www.fve.org

FVE/doc/14/061

Adopted on 22 November 2014

FVE 10 PRINCIPLES OF VETERINARY CERTIFICATION

The veterinary certificate, being a formal declaration of a veterinariani, plays an important role in the prevention and control of animal health and welfare issues and related public health issues. Veterinary certificates must be clear and reliable. For this reason the Federation of Veterinarians of Europe (FVE) developed a position paper outlining the main principles of veterinary certification. The paper was published in 1998 (FVE/98/053). Now, more than 15 years later, the time had come to revise and to update the original document. The FVE Veterinary Statutory Body Working Group proposed the following 10 principles of veterinary certification.

Disclaimer

These 10 principles represent best practice in veterinary certification

1. Veterinarians should certify only those matters, which are within their own knowledge, can beascertained or attested either personally or by another veterinarian, who has personal knowledge of thematters in question and is authorised to provide the certificate.

2. Veterinarians should not issue a certificate which might raise questions of a possible conflict ofinterest.

3. Veterinarians must not allow commercial, financial or other pressures to compromise theirimpartiality.

4. Certificates should be written in simple terms which are easy to understand.

5. Certificates should not use words or phrases, which are capable of more than one interpretation.

6. Certificates should be:

a. Produced on one sheet of paper or, where more than one page is required, in such a form that any two or more pages are part of an integrated whole and indivisible.

b. Given a unique number, and a record should be retained by the issuing person or by theInstitution or Company they work for.

7. Veterinarians should only sign certificates written in a language they understand.

8. Certificates should clearly identify the subjects of certification.

9. Veterinarians should only sign original certificates. Where there is a legal or official requirement for acopy of the certificate (marked as such) it can be provided.

10. When signing a certificate, veterinarians should ensure that:

a. Their signature is legible;b. The certificate bears not only the signature but also, in clear lettering, their name,

qualifications and address and (where appropriate) their official or practice stamp; c. The certificate bears the date on which the certificate was signed and issued and (where

appropriate) the time for which the certificate will remain valid;d. No part of the certificate is left blank so that it could subsequently be completed by some

person other than the veterinarian;e. The certificate contains no deletions or alterations, other than those initialled and stamped

by the certifying veterinarian.

i Defined by FVE as “a professional with a comprehensive scientific education, licensed by the legal authority, to carry out, in an independent, ethical and personally responsible capacity, all aspects of veterinary medicine, in the interest of the health and welfare of animals, the interest of the client and of the society”.

SC Apr 16 AI 03 (c) Annex B

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21. Draft amended guidance on Certification Introduction Please note that the term ‘veterinarian’ replaces ‘veterinary surgeon’ in this chapter of Supporting Guidance. This is because ‘veterinarian’ is commonly used in the context of European and International trade certification and has been used here for consistency. 21.1 Veterinarians are frequently required to sign certificates as part of their day to day professional duties. Some examples include signing pet or equine passports, fitness to travel certificates, fitness to breed certificates or equine pre-purchase examination (PPE) certificates. 21.2 Some veterinarians may also work as Official Veterinarians (OVs). These are practitioners, who are authorised by the UK Government to carry out certain duties, including certification responsibilities. Veterinarians in salaried employment of the UK Government, mainly Defra and its executive agencies (principally the Animal and Plant Health Agency – APHA) and the devolved administrations are also considered OVs. OVs may be asked to sign certificates relating to live animals or products of animal origin (for example, meat and dairy products, animal by-products, genetic material). 21.3 Veterinary certification plays a significant role in the control of animal health and welfare, the continuity of European and International trade and the maintenance of public health. Veterinarians have a professional responsibility to ensure the integrity of veterinary certification. The simple act of signing their names on documents should be approached with care and accuracy. 21.4 Veterinarians must certify facts and opinions honestly and with due care, taking into account the 10 Principles of Certification set out below. They should not sign certificates which they know or ought to know are untrue, misleading or inaccurate. This applies equally to hand-written, printed and electronic certificates. 21.5 Veterinarians should also familiarise themselves with the form of certificate they are being asked to sign and any accompanying Notes for Guidance, instructions or advice from the relevant Competent Authority. 21.6 This chapter of Supporting Guidance is intended to help veterinarians understand and meet their professional responsibilities in the context of certification. What is a certificate? 21.7 A certificate is a written statement made with authority; the authority in this case coming from the veterinarian’s professional status. 21.8 It should be noted that not all certificates contain the word ‘certificate’. Some documents (for example, forms, declarations, insurance claims, witness statements and self-certification documents) may involve the same level of responsibility even if they do not contain the word ‘certificate’.

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The 10 Principles of Certification (formerly 12 Principles) 21.9 The 10 Principles of Certification provide the foundation of certification for all those who draft or prepare, use or sign veterinary certificates. In short, the principles represent best practice in veterinary certification. From time to time, veterinarians may be presented with certificates that do not conform to all of the principles. Veterinary surgeons should read paragraphs 21.34 to 21.35 below for more information on dealing with these types of certificates. 21.10 The current 10 Principles have replaced the 12 Principles of Certification (previously drafted by the RCVS, BVA and Defra) in order to better reflect modern certification practice. 21.11 The 10 Principles are set out in bold below. These are followed by additional guidance on how the principles can be applied in practice. No. Principle of Certification 1. A veterinarian should certify only those matters which:

a) are within his or her own knowledge; b) can be ascertained by him or her personally; or c) are the subject of supporting evidence from an authorised veterinarian who has

personal knowledge of the matters in question.

In some circumstances, a certificate or the accompanying Notes for Guidance may allow a veterinarian to attest matters on the basis of a declaration by another person e.g. the exporter or their agent, a farmer, transporter, animal health officer or business food officer. Matters not within the knowledge of a veterinarian and not the subject of supporting evidence but known to other persons, e.g. the farmer, the breeder or the truck driver, should be the subject of a declaration by those persons only. The form of declaration may vary from a simple signed statement to a sworn affidavit depending on the significance of what is being certified and the requirements of the Competent Authority. Veterinarians should retain copies of any declarations and make a record of any checks or procedures undertaken to corroborate these declarations, where appropriate. 2. Veterinarians should not issue a certificate that might raise questions of a possible

conflict of interest.

Generally speaking, conflicts of interest should be avoided. Veterinarians signing certificates should not allow commercial, financial or other pressures to compromise their impartiality. In the context of Trade Control and Expert System (TRACES) Intra Trade Animal Health Certificates (ITAHCs), veterinarians should not certify where they own or part own either a business producing a commodity for export or the commodity to be exported, or are a salaried employee of the business. Veterinarians should contact APHA for further advice on conflicts in this context. Veterinarians should consider the potential conflict of interest and make their own decision on whether a conflict exists. They may also wish to seek advice from the RCVS or the Competent

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Authority. Veterinarians should make a record of any potential conflict of interest and the advice received. 3. A veterinarian should only sign certificates that are written in a language they

understand.

In some cases, certificates may be accompanied by an official translation of the certificate into a language of the country of ultimate destination. Translated certificates are only a requirement if specifically requested by the country of destination. In the case of a Third Countries, any agreed certificates tend to be bilingual. In the case of ITAHCs, the TRACES system allows for the equivalent in the language of the Member State of destination to be provided. Whatever the case, veterinarians should comply with any official Notes for Guidance accompanying the certificate or advice from the Competent Authority. 4. A veterinarian should not certify that there has been compliance with the law of another

country or jurisdiction unless the provisions of that law are set out clearly on the certificate or have been provided to them by the Competent Authority in writing.

Veterinarians should read and understand any Notes for Guidance or supporting material issued by the Competent Authority. If there is any ambiguity, the veterinarian should seek advice from the Competent Authority on how to proceed. 5. A veterinarian should only sign original certificates. Where there is a legal or official

requirement for a certified copy or duplicate (marked as such) these can be provided.

Veterinarians may need to provide certified copies or duplicates where originals have been damaged or lost (e.g. where damage has occurred during transit). Where a copy or replacement is provided or retained it must be clearly marked COPY or DUPLICATE or REPLACEMENT, as appropriate and in accordance with any Notes for Guidance. Where practicable the veterinarian should ensure that the certificate being replaced is surrendered or withdrawn and either destroyed or clearly identified as to its revised status. Where veterinarians become aware that the certificate should not have been issued or is no longer true, they must withdraw or cancel the certificate, identify the copies accordingly, and inform the affected parties of their action as soon as reasonably practicable. Copies should also be provided to the Competent Authority. 6. When signing a certificate, a veterinarian should ensure that:

a) the certificate contains no deletions or alterations, other than those which are

indicated on the certificate to be permissible, and subject to such changes being initialled and stamped by the certifying veterinarian;

b) no section of the certificate is left incomplete ; c) the certificate includes not only their signature but also, in clear lettering, their name,

qualifications and address and (where appropriate) their official or practice stamps; d) the certificate includes the date on which the certificate was signed and issued and

(where appropriate) the time for which the certificate will remain valid.

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Veterinarians should complete certificates with care and accuracy and in a manner and using a means which does not lend itself to alteration, or additions, by a second party after the certificate has been issued. It is recognised that mistakes on certificates can occur and these should be rectified, as permissible, as soon as they are identified.

Veterinarians might also give consideration to using their RCVS membership number on the certificate. This provides an easy means of identifying the certifying veterinarian and their contact details should these be required.

Incomplete sections should be avoided so the certificate cannot be subsequently completed by someone other than the certifying veterinarian.

In the absence of procedures such as embossing, it remains advisable for manuscript insertions to be completed in coloured ink rather than black.

Generally, manuscript insertions and any pre-printed list of options, which can be deleted in a certificate, do not have to be initialled, stamped, and dated unless the Notes for Guidance request this. Veterinarians should always refer to the Notes for Guidance or Competent Authority if there is any ambiguity.

7. Certificates should be written in simple terms which are easy to understand.

8. Certificates should be:

a) clear and concise; b) integrated, whole and indivisible c) given a unique identifier; and d) copied and retained with all relevant records.

Veterinarians should retain copies of certificates for their own records and provide copies to the Competent Authority, as required.

9. Certificates should not use words or phrases which are capable of more than one interpretation.

10. Certificates should clearly identify the subject being certified.

There are some exceptions to this general rule, specifically cases where it is impractical to identify the subject (for example, day old chicks). Veterinarians must also comply with any Notes for Guidance from the Comptetent Authority on identification as there may be specific advice on how identification should be carried out and recorded. (See 21.30 to 21.33 below for general advice on identification of animals).

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Official certification for export of live animals and animal products 21.12 Veterinarians involved with official certification should familiarise themselves with all regulatory requirements, instructions and guidelines pertaining to the particular category of official assurance being dealt with. They should read and understand any supporting explanatory material and check carefully for any ambiguity or incompatibility with the Competent Authority. Veterinarians should also ensure they have the necessary prior authority and knowledge before issuing any particular category of official assurances. 21.13 Where appropriate Notes for Guidance should be provided to the certifying veterinarian by the Competent Authority indicating the extent of the enquiries he or she is expected to make; the examinations he or she is required to carry out; or to clarify any details of the certificate which may require further interpretation. Some certificates are self-explanatory but ITAHCs and most Third Country certificates are highly complex and need further guidance to allow veterinarians to sign these. The RCVS strongly encourages Competent Authorities to provide clear Notes for Guidance to certifying veterinarians, where appropriate. 21.14 In cases where further advice or clarification is sought, veterinarians should record, in writing, the information received, the date and time it is received and the name and details of the official giving the advice. Veterinarians should expect their own queries to be similarly recorded. They may request and expect to receive written confirmation of the guidance given to them. 21.15 Guidance issued by the Competent Authority for the completion of these certificates should be scrupulously followed. When problems are identified, Defra or APHA (or the equivalent body in the devolved administrations) should be consulted and, if not then resolved, the advice of the RCVS should be sought. 21.16 In some cases, advice from the Competent Authority may not be available (e.g. during holiday periods or out of hours). In such emergency situations veterinarians may wish to consult an experienced colleague for advice and make a note of the discussion. Veterinarians should also comply with any practice policies on seeking external advice.

21.17 A veterinarian who acts in an official capacity must only use an official stamp issued to him or her on official certificates issued or approved by the Competent Authority.

Recognition of the role of paraprofessionals in assisting official certification 21.18 In certain limited situations veterinarians may rely on third party attestations by authorised persons. Generally there will be express provision for this in legislation. By way of an example, current EU legislation which specifies the official controls on products of animal origin intended for human consumption allows the use of trained official auxiliaries to carry out the veterinary checks under the supervision of the OV in certain situations. An ‘official auxiliary’ means a person qualified, in accordance with the Regulation, to act in such a capacity, appointed by the Competent Authority and working under the authority and responsibility of an OV. In some legislation the term “veterinary checks” does not necessarily mean that all the checks must be carried out by an OV. 21.19 Veterinarians should comply with relevant legislation in the jurisdiction(s) in which they practise and be familiar with any special rules or requirements of the particular industry in which

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they practise. Veterinarians should also comply with any guidance from the Competent Authority when certifying on the basis of checks carried out by paraprofessionals. Remote certification of low risk products by Official Veterinarians (OVs)

21.20 In some limited circumstances as agreed by the Competent Authority it may be appropriate for veterinarians to certify low risk products remotely based on knowledge of the production plants and working processes. Requirements for remote certification will need to be agreed with the Competent Authority and veterinarians should be familiar with these requirements before proceeding.

21.21 In these limited cases, where the product is the result of an industrial process, and the OV inspects the production establishment periodically and checks the quality control systems that are in place, and the certificate does not require the OV to be present at the time of loading, then the consignment could be certified in advance of loading. In order for this to happen certain strict conditions should be met such as:

a) there is no requirement in the certificate for sealing or identification of transport; b) the consignment is identified by marks and all necessary tests have been completed

satisfactorily; c) the certificate describes the consignment such that substitution with product, which had not

been inspected, would not be possible; d) there are accurate, up-to-date and accessible records from audited systems which can be

used to confirm that the consignment complies with the certification requirements; and e) the certifying veterinarian carries out regular audits of the production plant, is familiar with its

quality assurance systems and is confident to rely on records;

21.22 Under these circumstances, veterinarians would be able to judge whether it is necessary to personally inspect consignments at the time of certification, but in doing so must be in a position to provide a clear account of the factors which led them to that decision. If the veterinarian is not present at the time of loading then it would be the responsibility of the exporter to ensure that the correct products are loaded into the means of transport.

21.23 Veterinarians should always seek advice from the Competent Authority before considering remote certification as this will not be acceptable in all cases.

Electronic certification

21.24 The RCVS considers electronic veterinary certificates are acceptable, subject to sufficient safeguards and security.

21.25 An example of a system that has been accepted by the RCVS is TRACES (Trade Control and Expert System), an EU-wide electronic certification and notification system that is being phased in for the provision of export health certificates and supporting documents for intra-Community trade in certain circumstances; and currently used by DEFRA. Other examples might include electronic signatures on pre-purchase examination or other certificates.

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21.26 Veterinarians asked to complete any form of electronic certification (including the use of electronic signatures) should consider whether there are sufficient security and controls (e.g. system encryption, passwords, etc) to avoid unauthorised access to and use of the veterinarian’s electronic identity. Veterinarians should also consider whether the certificate is unalterable and lockable to avoid unauthorised modification or manipulation once it has been signed. In most cases, veterinarians will need to seek advice from those with relevant knowledge to give assurances about how to meet these requirements. The RCVS cannot provide this type of technical advice.

21.27 For advice on the deployment of digital signature within the TRACES or any other export certification system, veterinarians should contact the Specialist Service Centre for International Trade – Carlisle: http://www.defra.gov.uk/ahvla-en/imports-exports/international-trade/ It is essential that veterinarians do not consider using electronic signatures or producing electronic versions of official certificates without first discussing the implications with the Competent Authority.

21.28 Veterinarians should keep a copy of the completed certificate to ensure that a trail of document ‘originals’ can be maintained, particularly if the document is likely to pass through a sequence of electronic ‘hands’.

21.29 Veterinarians engaged in providing certification or other formal correspondence solely through electronic means should familiarise themselves with the relevant provisions of the UK legislation: the Electronic Communications Act 2000 and associated regulations. Veterinarians seeking further information on the regulations should contact the Department for Business, Innovation & Skills (BIS) on 020 7215 5000 or by e-mailing [email protected]

Identifying animals on certificates 21.30 If an alleged identification mark is not legible at the time of inspection, no certificate should be issued until the animal has been re-marked or otherwise adequately identified. 21.31 When there is no identification mark, the use of the animal's name alone is inadequate. If possible, the identification should be made more certain by the owner inserting a declaration identifying the animal, so that the veterinarian can refer to it as 'as described'. Age, colour, sex, marking and breed may also be used. 21.32 The owner's name must always be inserted. (In the case, for example, of litters of unsold puppies this will be the name of the breeder or the seller.) 21.33 Where microchipping, tattooing or any other form of permanent identification has been applied it should be referred to in any certificate of identification. How to deal with certificates that do not conform to the 10 Principles Remembering the four ‘C’s of Certification

21.34 Veterinarians may be presented with certificates that do not conform to all of the 10 Principles. In such cases the RCVS strongly advises that veterinarians should:

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http://www.defra.gov.uk/ahvla-en/imports-exports/international-trade/



CAUTION

a) Scrutinise the document, whatever its title, before adding their signature to this b) Be clear as to whom they are responsible in exercising their authority when they sign the

document

CLARITY

a) Read and understand any explanatory supporting material b) Check carefully for any ambiguity which should be clarified with whoever has issued the

certificate CERTAINTY

a) Be sure that they attest only to what to the best of their knowledge and belief is true b) Do not attest to future events c) Take great care when attesting to what others have declared or asserted

(Veterinarians may attest to what another veterinarian has certified. They may also attest to the fact that a declaration or assertion has been made by another person without attesting to its validity). CHALLENGE If they have gone further in what they have attested, veterinarians must consider what their defence would be if challenged, and keep appropriate written records made at the time of the decision to sign. For example, if challenged under the Animal Health Act 1981 (as amended) with false certification could they show (in the words of that Act):

a) that he did not know of that falsity and that he could not with reasonable diligence have obtained knowledge of it or, if challenged under the Trade Descriptions Act 1968 (as amended) could they show (in the words of that Act):

b) that the commission of the offence was due to a mistake or to reliance on information supplied to him or to the act or default of another person, an accident or some other cause beyond his control; and

c) that he took all reasonable precautions and exercised all due diligence to avoid the commission of such an offence by himself or any person under his control.

21.35 When faced with a certificate that does not confirm to the 10 Principles, veterinarians should take a professional, reasonable and pragmatic approach, bearing in mind the general advice above. Additional matters 21.36 On occasion veterinarians may be asked to attest ‘to the best of their knowledge and belief’. In these circumstances, veterinarians should exercise caution and attest only to what to the best of their knowledge and belief is true. They should not attest to future events and they should take great carewhen attesting to what others have declared or asserted, without giving any apparent thought to the ’Four Cs’ outlined above in paragraph 21.34 to 21.35 above.

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Storage and retention of certificates 21.37 The RCVS does not specify for how long copies of certificates, declarations or clinical records should be retained. For official certificates, veterinarians should follow any guidance from the Competent Authority. In the event of future disputes, veterinarians should also comply with any professional indemnity policy conditions relating to retention of records.

Vaccination record cards 21.38 Veterinarians should take care when completing vaccination record cards even though they are generally regarded as part of the clinical records and not a certificate. This applies whether the record cards are in paper or electronic format. There is more detailed guidance on the professional responsibilities associated with completing records cards in Supporting Guidance Chapter 13 ‘Clinical and Client records’, paragraphs 13.7 to 13.9.

Maintaining the integrity of veterinary certification 21.39 Misleading, incomplete, inaccurate, or untrue certification reflects adversely on the veterinarian signing and calls his or her professional integrity into question. This also impacts adversely on the general reputation of the veterinary profession. Certification of this nature may also expose the veterinarians to complaints and cases may come before the RCVS Disciplinary Committee arising from allegations of false or dishonest certification.

21.40 There are four main hazards for veterinary surgeons when ’certifying‘ in the wider sense:

a) Negligence: a breach of the duty owed to a relevant party with consequent damage. Negligence may arise from a failure to disclose all of the material facts or supplying incorrect information. The consequence may be civil court proceedings.

b) Criminal offences: criminal offences may be committed under trade descriptions legislation, legislation controlling animal exports and by aiding and abetting a third party. They may include fraud, or knowingly or recklessly supplying false information. Any conviction brought to the notice of the RCVS may be considered in relation to the fitness of the veterinarian to practise.

c) Professional misconduct: even if no criminal charges are brought, an aggrieved party or

enforcement authority may make a formal complaint to the RCVS. Any action by a veterinarian which brings the integrity of veterinary certification into disrepute is considered seriously by the RCVS. If the complaint is judged to be justified, penalties may follow.

d) Loss of OV status: misleading, incomplete, inaccurate, or untrue certification in the context

of official work adversely affect animal welfare and public health, can result in the spread of disease, result in financial loss to clients and exporters and may cause inter-Governmental difficulties. Veterinarians may therefore put their status as an OV at risk if they do not follow certification compliance requirements set out by the relevant Competent Authority.

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SC Apr 16 AI 03(c) Annex D

Extract from the Wooler Report (page 26)

The gathering and presentation of veterinary evidence

22. Inspectors should be formally instructed not to seek certification by a veterinary surgeon under section 18 of the Animal Welfare Act 2006 unless the vet has examined the animal(s) in question.

23. The RSPCA should take the lead in inviting the Royal College of Veterinary Surgeons and other practitioners to develop a common standard or guidance on the approach to assessment of suffering.

24. The RSPCA should establish a panel of accredited veterinary practitioners (with known specialisms where practicable) to be drawn upon by inspectors requiring examination of case animals. Vets on the panel should be expected to work within a fee structure and to a service level agreed with the RSPCA.

25. The RSPCA should develop a policy as to the extent of its reliance on case vets as expert witnesses; and as to the circumstances in which further expert evidence should be sought. Where further such evidence is to be sought, instructions to veterinary surgeons should be case specific and developed by or in collaboration with the Prosecutions Department.

26. The Society’s Chief Veterinary Officer should take the lead in providing advice and guidance to the Inspectorate and the Prosecutions Department in relation to the issues identified in this chapter.

Extract from the RSPCA reposnse to the Wooler Report

The gathering and presentation of expert evidence [rec. 22-26]

The RSPCA has agreed that veterinarians should only be asked to sign a s18 AWA certificate (which enables the police to exercise statutory powers to take an animal into possession or alleviate an animal’s suffering) when they can personally verify the facts. Updated guidance has been given to the Inspectorate to ensure compliance.

Defining suffering for court proceedings is challenging and, after consultation with the RCVS and veterinary practitioners, it has been agreed that it it is appropriate to rely on the Oxford English Dictionary definition.

Our guidance for veterinarians that we use will include a suggested common standard for body condition scoring.

To improve transparency and harmonise how the Society delivers veterinary evidence to the courts, we have established a non-exclusive ‘panel’ of veterinarians using RCVS accreditations. It is hoped such an approach will strengthen relationships with the veterinary profession, speed up case progression and reduce costs.

The RSPCA has agreed and implemented a new Expert Witness policy, which clarifies when additional opinion is to be obtained in addition to the examining veterinarian’s expert opinion.

The Chief Veterinary Officer’s role now encompasses an advisory role to the Inspectorate and Prosecutions department on veterinary issues in prosecutions to provide a veterinary oversight within the RSPCA.

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SC Apr 16 AI 03(c) Annex E

22. Giving evidence for court Introduction

22.1 Witnesses are an essential part of the legal process, providing factual or opinion evidence. The aim of this guidance is to explain to veterinary surgeons and veterinary nurses the differences between factual and opinion evidence and the responsibilities associated with acting as either a factual, professional or expert witness. Veterinary surgeons and veterinary nurses may feel awkward about giving evidence ‘against’ a colleague or client, but this is to misunderstand the essential role of a witness: to assist a court’s determination of the facts and issues.

What is factual evidence?

22.2 The Court’s powers to exercise legal sanctions and to apply legal rules depend on the proof of particular facts. The law establishes which facts have to be proven in any given case, by whom and to what standard of proof. These facts are proven by the evidence, usually by testimony evidence (calling witnesses to testify) but also by documentary evidence (evidence contained in a document) and real evidence (which is derived from the physical nature of an object or place and observed upon an examination or visit).

What is the standard of proof?

22.3 The overall legal process of proof in court requires a combination of facts and arguments to prove cases. The rules of evidence and of court procedure draw a distinction between facts, which are proven by the evidence, and arguments, which are advanced later by the advocates in the case. Every allegation in a case must be established to a particular ‘standard of proof’, which is set by the law, and is generally imposed on the party bringing the case (i.e. the claimant in civil cases, the prosecution in criminal cases). This is called the ‘burden of proof’. The standard of proof for civil cases is ‘on the balance of probabilities’; the standard of proof for criminal cases is ‘beyond reasonable doubt’; the standard of proof for RCVS disciplinary matters is ‘so as to be sure’ (the highest civil standard of proof which is tantamount to the criminal standard).

What is the role of a witness?

22.4 The Court will receive evidence of fact from a witness for consideration in a case. The evidence of a factual witness is usually presented by the witness attending court, swearing an oath (or affirming), and then going into a witness box to give his or her evidence orally in court. In England and Wales, the Courts’ rules of procedure also allow for reliance on written, sworn witness statements in place of calling a witness to give evidence orally. In Scotland, such statements require to be given on oath before a commissioner appointed by the court, and are only permitted in circumstances where the witness is unable to attend court due to circumstances such as ill health, old age or a requirement to be abroad when the case is heard in court. By contrast, in Northern Ireland, it is very rare for statements to be accepted in place of oral evidence. Each statement of fact by the witness is evidence of that fact, and once the evidence has been ‘given’ on oath, it becomes ‘sworn evidence’ or ‘testimony’.

22.5 A veterinary surgeon or veterinary nurse may be called as a witness of evidence of fact. This means the veterinary surgeon is being asked to tell the court what he/she personally saw, said or did. This is different from evidence of what another person told them they had seen, done or said which is called ‘hearsay evidence’

What is opinion evidence?

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22.6 By contrast, the opinions of lay witnesses are not generally admissible as evidence in Court: this is called ‘the rule against opinion evidence’. (Although no such ‘rule’ applies in Scotland, the Scottish courts apply the same principles). This rule or these principles are adopted because opinions and conclusions are for the Court to reach, based upon its assessment of the information placed before it: its factual conclusions will be (or should be) based upon the evidence of fact put before it; its legal conclusions will be based on its application of the law to the facts it has found, having regard to the legal arguments put before it by the advocates. Thus a witness of fact should not in ordinary circumstances be asked questions, or offer answers, which require the witness to venture an opinion on a fact in issue. This applies to statements made in preparation for giving evidence in Court as well as when giving evidence in Court, although there are exceptions to this which will be explained below.

When is opinion evidence received in Court?

22.7 Opinion evidence is received when the Court requires additional assistance to form an opinion on, and thereby decide justly, a particular issue which concerns matters of specialised knowledge and expertise.

22.8 The principal exception to the general rule excluding evidence of a witness’s opinion is in respect of ‘expert evidence’ given by an Expert Witness. This opinion evidence may be admitted provided the court is satisfied that the witness is qualified to give that opinion by relevant learning and experience. These witnesses often play an important role in cases involving veterinary science. See paragraphs 22.12 to 22.17 below.

22.9 There are also instances where the opinion evidence of a professional witness to fact will be accepted. See paragraphs 22.10 and 22.11 below.

What is a professional witness?

22.10 A ‘professional witness’ is one who by reason of some direct professional involvement in the facts of a case is able to give an account of those facts to the court. Thus a professional witness is a witness of fact, who is also professionally qualified. This factual evidence is admitted when the facts in question are relevant to an issue which the court is to decide. 22.11 However, there will also be occasions when a professional witness of fact will be asked by an advocate or by the court to explain the reasoning which underlay his/her findings made or actions taken in respect of a given animal. This will most commonly arise where the witness was a treating clinician, and the professional witness in these circumstances (and subject to the court’s permission) will be able to give an answer which involves evidence of opinion. As to this situation see further below.

What is an expert witness?

22.12 An expert is anyone with knowledge or experience of a particular field or discipline beyond what is expected of a layman. An expert witness is a person who is qualified by his or her knowledge, experience or formal qualifications, to give an opinion to a Court on a particular issue to assist the Court in deciding the matter or case before it. 22.13 The evidence that expert witnesses can give is called ‘expert opinion evidence’, and this evidence is used and admitted where the Court lacks competence due to a lack of necessary expertise. The expert witness’s primary responsibility or overriding duty is to the Court, even if they are called and paid for by one of the parties to the case. This leads to an expert witness sometimes being referred to as ‘independent’. The expert witness is usually asked to provide a report and may also be called to give evidence, on behalf of the instructing party, in Court. Nevertheless they must remain independent of their party’s vested interest.

22.14 Often, academic eminence in the relevant field is useful, as is an impressive set of qualifications and past relevant experience. However, in modern court cases an expert witness is also expected to have a sound and practical knowledge of the subject matter, based on actual

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clinical or practical experience, which is preferably ongoing at the time of the court case, or the time of the incident. The expert witness may be subjected to cross examination in the witness box of their self-professed standing as ‘expert’ on the subject matter in dispute. The easiest way for an advocate to seek to discredit a ‘retired’ clinician undertaking expert witness work is to ask and elucidate the date on which they last carried out the procedure in question, or treated the condition in question, to find that the answer is “some years ago”. The expert witness should be prepared to deal with such questions and should not undertake expert witness work unless they have the relevant expertise and ongoing or recent experience.

22.15 Other qualities of a good expert witness include self-confidence and the ability to inspire and command confidence in others, particularly in the witness box; the ability to give a concise opinion which can be understood by lay people and, the ability quickly and promptly to adapt to changing information.

22.16 Generally, expert witnesses are sent all relevant reports and witness statements for the purpose of compiling their expert report and (save in Scotland) will hear all the evidence before giving their expert evidence. (In Scotland, expert witnesses are not permitted to hear the evidence of other expert witnesses before they themselves appear to give evidence. They are permitted to hear witnesses of fact but in reality parties can rarely fund their expert to be in attendance throughout the court hearing).

22.17 For further guidance as to the role of an expert witness is published by the British Medical Association and the General Medical Council.

Guidance for writing an expert report

22.18 It is important to remember, as an expert witness, that although you will be retained by your client (or clients), your primary duty is to the Court and that you are expected to remain objective, impartial, independent, and to act with integrity. You must not compromise on these matters, or act where there is an actual or potential conflict of interest unless this conflict is disclosed. An expert witness is also under a duty to maintain confidentiality. If you are going to undertake expert witness work regularly, you would be well advised to join an appropriate organisation such as the Academy of Experts, the Institute of Expert Witnesses, the Veterinary Association for Arbitration and Jurisprudence or the Council for the Registration of Forensic Practitioners: see List of Experts below.

22.19 The content of the expert’s report will depend on the purpose for which it is prepared, but it should aim to be a clear, precise and convenient resource of information. Experts’ reports are used to provide advice as to the merits of a case as well as for the purpose of disclosure in proceedings. In both instances the report is intended to assist non-experts (including the judge and advocate (counsel/barrister/solicitor-advocate)) in understanding the matter in issue from a technical, clinical or scientific point of view. The report may provide the stimulus for pursuing a claim; it may form the basis for drafting the statements of case/statements of claim on which claims are based, or it may provide material for cross examination at trial. An expert’s report may be disclosed to the opposing side, either before proceedings are issued or afterwards, at which point the report’s author may be called upon to answer and address the opposing side’s challenges to the opinions expressed in the report.

22.20 There are certain minimum requirements for an expert’s report to be acceptable to a court in civil proceedings. It must be prepared according to the provisions and requirements of the latest version of the Civil Procedure Rules (CPR) and their Practice Directions (PD), especially CPR Part 35 and PD 35 (England and Wales), the County Court Rules and Rules of the Supreme Court for the High Court and Practice Direction Number 1, 2003 (Northern Ireland) and similar requirements for Scotland. For example;

a. the report should be addressed to the Court not the client; b. it should contain an expert’s statement of truth/declaration and qualifications;

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c. if a range of opinion on a particular issue exists and it is relevant to the matter in hand, this should be referred to and addressed;

d. relevant sources of evidence or literature cited or relied upon should be included in a bibliography;

e. any technical terms used should be explained; matters of fact should be clearly distinguished from matters of opinion. See Civil Procedure Rules Part 35 and PD 35.

22.21 The exact layout of the report is left to the practice of the individual expert, but the report must state the expert’s name, the name of the party instructing them, the date of the report, include an expert’s declaration and statement of truth and be signed by the expert. A good basic format is to have:

a. a cover sheet (with identification information) b. a table of contents c. a summary of conclusions (this may come at the start or the end of the report) d. a summary of instructions e. a list of documents or evidential sources f. a chronology (if appropriate for the case) or a factual summary g. a technical section (to permit a lay person reader to understand the opinion and summary of

conclusions sections) h. an opinion section i. a brief curriculum vitae of the expert’s qualifications and experience j. a bibliography of literature (if any literature or works of reference are cited or relied upon) k. a paginated sequence of numbered and headed sections composed of short, suitably

headed paragraphs. 22.22 Model reports may assist as a starting point: see the Expert Witness Institute model report.

22.23 For further information as to experts’ Codes of Practice, Protocols, Procedural Rules (both criminal and civil), model form of reports, model terms of engagement, Expert’s Declarations, see: The Expert Witness Institute Website: www.ewi.org.uk and the Academy of Experts Website: www.academy-experts.org.

What is the difference between an expert witness and a professional witness?

22.24 An expert witness is asked to provide an expert opinion in respect of a particular set of facts or on a particular issue, a professional witness is asked to testify solely on the observed facts of the matter or particular issue. However, (as indicated above) there is a ‘grey area’ which arises because the professional witness, in the course of carrying out his or her professional role, will have formed a professional opinion based on the observed facts, e.g. a view as to the patient’s condition or a possible diagnosis following a clinical examination is such an opinion. A ‘professional witness’ should be aware that when providing testimony of fact they should only testify as to the observed facts, but that they could be led by others, either a prosecutor or advocate, into giving an opinion, and straying into expert territory. If this happens then (save for cases in Scotland) the ‘professional witness’ should seek clarification, perhaps from the judge, as to whether or not they may answer these questions. A witness gives either evidence of fact or opinion evidence and there is no category of professional evidence. In Scotland, an expert who is a professional and also a witness to fact may give evidence as to both fact and opinion. 22.25 A veterinary surgeon who is asked to prepare a report should establish whether the report is required from them as a professional witness (of fact) or as an expert witness. Generally, ‘professional witnesses’ should avoid giving opinions on the central issue in the case, or accept that they are acting as an expert witness.

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http://www.ewi.org.uk/

http://www.academy-experts.org/


22.26 If a ‘professional witness’ gives an opinion on the central issue in a case (for example, that the animal is suffering unnecessarily, or is likely to suffer unnecessarily, or the animal’s needs have not been met) he or she should:

a. Consider all the relevant facts available in the case, for example, the animal owner’s explanation, whether food or treatment has been given, the results of any post mortem, other laboratory evidence or test results etc; as well as what evidence may be necessary before an opinion can properly be given; and update the opinion as additional information becomes available.

b. Include in the witness statement the facts on which the opinion is based; the experience or qualifications in addition to the veterinary degree and registration with the RCVS; any other literature or material relied upon in giving the opinion; any alternative veterinary views which may reasonably be held; acknowledgement that the primary responsibility of a person giving opinion evidence (an expert) is to the court.

c. Disclose to the party instructing you, any relationship with any other party in the case, including the prosecuting organisation or relevant enforcement authority which could give rise to a conflict of interest.

Remaining within one’s expertise

22.27 It is good clinical practice to remain within the scope of one’s expertise. The same applies when undertaking both professional witness and expert witness work. Both types of witness should be aware of being drawn or pressurised into giving evidence or expressing opinions which are beyond their level of experience or expertise. Professional and expert witnesses can expect to be challenged in the witness box if they stray outside their own expertise, and should be firm and clear (both with those instructing them and the Court) as to the boundaries of their expertise and experience. A failure to remain within one’s expertise when acting as a professional or expert witness could also potentially lead to disciplinary proceedings. (See the Court of Appeal decision in the case of Meadow v General Medical Council [2006] EWCA Civ, 1390, [2007] QB 462) 22.28 When faced with such a situation, just as in clinical practice, the veterinary surgeon should defer to a more senior or more experienced colleague, or to another source or form of expertise. The circumstances in which such a situation can arise may be less than clear cut. For example, whereas most veterinary surgeons may consider themselves competent to state whether or not a dog was emaciated, the same may not be said for an emaciated horse; it may not always be clear to a non-specialist veterinary surgeon that a particular species of animal is suffering distress in a particular set of circumstances

When should evidence be collected?

22.29 It may not always be clear from the outset of a clinical case that evidence (in the form of samples) should be collected and retained. Veterinary surgeons should be alive to the possibility of a clinical case developing into a legal case, whether criminal (e.g. poisoning) or civil (e.g. negligent misdiagnosis), and, if suspicious or unsure, veterinary surgeons should consider collecting and retaining samples, with the consent of the owner of the animal or the person in control or possession of the animal. Apart from assistance from more senior colleagues, veterinary surgeons are advised to consider contacting the police, RSPCA or local authority officers if they are unsure about whether to collect evidence.

How to take evidential samples

22.30 To be of any evidential use in a legal case, the source or provenance and the whereabouts of the samples must be recorded to ensure there is ‘continuity of evidence’. This

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applies to the collection, handling and despatch of samples. Practically speaking this means knowing and being able to state where the sample has been and how it has been stored from the moment it was taken. Taking these precautions will minimise the risk that the evidence could be subsequently challenged (as having been contaminated or tampered with) and rejected. (In Scottish cases, it is recommended that two witnesses should be called to verify the above details in order that the information is corroborated.)

22.31 The samples must also be appropriately collected, labelled and stored. The appropriate method of collection and storage depends upon the nature of the sample. Diagnostic laboratories will be able to give some assistance as to how samples should be collected, sealed and stored.

22.32 As a minimum, the sample should be labelled with the case name or other unique identification and the date of collection. In some situations two, or even three, identical samples should be collected, labelled separately and stored.

The analysis of the samples

22.33 Consideration should always be given to sending the samples for analysis to quality-controlled external laboratories, rather than attempting to conduct analysis using in-house equipment or inexpert staff. Again, this precaution will minimise the risk that the evidence could be subsequently challenged as inconclusive or incorrect.

Format of a court case

22.34 In the case of a criminal trial, the Prosecutor (in England and Wales a Crown Prosecution Service advocate acting on behalf of the CPS, in Northern Ireland a Public Prosecution Service lawyer acting on behalf of the PPS, in Scotland the Procurator Fiscal or Advocate Depute, or other non-police prosecuting agency) will open the case, usually in the form of a summary of the Prosecution’s case, the evidence and the law. The Prosecution will then ‘call’ its witnesses, one at a time. Each witness will swear or affirm (by reading the oath or affirmation from a card provided by the court’s usher or clerk) and will then give their evidence (called ‘evidence in chief’) from the witness box. The witness will then be cross-examined by the Defence lawyer, and may be re-examined by the Prosecution lawyer. At any stage the judge or, in the Magistrates’ Court, the magistrates (‘the bench’) (in Scotland, sheriff) may also ask questions. The same procedure is then followed by the Defence. Save for Northern Ireland, there may also be witness statements read to the court in the absence of that witness (for example because the evidence is agreed between the parties or the witness is too ill to attend – but see paragraph 4 above regarding Scottish witness evidence). When all the witness evidence has been heard, the Defence lawyer and the Prosecutor may give closing speeches, summing up the evidence that has been heard and applying the law to the evidence as they see it.

22.35 In a Magistrates’ Court (or, in Scotland, Sheriff Court) trial, the bench or resident magistrate will usually retire to consider their verdict. On their return to the court room the Chairman of the bench or resident magistrate or sheriff will announce the verdict of ‘guilty’ or ‘not guilty’ (or, in Scotland, a verdict of 'not proven' is additionally available) and give reasons. If the verdict is guilty, pleas in mitigation will then be heard. If there is a bench they will again retire to consider sentence, and will return to announce the sentence. If the case is before a resident magistrate (Northern Ireland) (s)he will similarly proceed to sentence.

22.36 In a Crown Court trial, the judge will sum up the case and the Jury will then retire to consider their verdict. On their return to the court room the Chairman of the Jury will announce the verdict when asked by the judge. If the verdict is guilty, pleas in mitigation will then be heard. The judge will then determine the sentence.

22.37 In the case of a civil trial, heard in the County Court or High Court, there is no Prosecutor. The case is brought by a Claimant ('Plaintiff' in Northern Ireland, 'Pursuer' in Scotland) and defended by a Defendant ('Defender' in Scotland). Broadly the same procedure is followed as in

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criminal trials, but often there is no opening of the case by the Claimant’s lawyer, and (save for Northern Ireland) witness’ evidence in chief is usually taken to be the witness statement that has been prepared and lodged at court on their behalf. (In Northern Ireland, evidence in chief is still formally given orally and statements are not commonly used).

22.38 In the case of a civil proof, heard in the Sheriff Court or Court of Session in Scotland, the Pursuer’s evidence is led first, followed by that of the Defender. The normal procedure is for all evidence to be led orally at the hearing, except in special circumstances where the evidence of witnesses is taken prior to the hearing (see again paragraph 4 above). The Sheriff or Judge(s) will usually, having heard the case, retire to consider their judgement and deliver this in writing thereafter. There is the possibility to have a civil case heard before a jury in the Court of Session.

Preparing for court

22.39 If a witness statement has been prepared on your behalf you should re-read this to remind yourself of your evidence. If you are engaged as an expert witness you should re-read your report, the reports of other experts and all documents appended to those reports.

22.40 Check in which court your case is to be heard and find out the location of the court and whether there is parking at the court or nearby. Plan to arrive in good time for the hearing allowing for journey time (you may wish to consider staying locally the night before).

22.41 When you arrive at court you will have to pass through a security scanner, after emptying your pockets. Once inside the court look for the court listing sheets (usually pinned to the walls or in glass fronted cabinets). These set out the court lists for each judge in each court room. Once you have found the case name, note the judge’s name and the court number and its location. If you cannot find any court listing sheets ask the usher, clerks or other court staff as sometimes they are delayed in posting the lists. (When attending either the Court of Session or any Sheriff Court in Scotland, witnesses should speak to staff on the front desk for directions to the appropriate court). When attending court you should dress appropriately in a suit – a trial is a formal occasion. Ensure that your mobile phone or pager is turned off or switched to silent.

22.42 You will probably hear how the judge is addressed before you start to give your evidence or you can ask the Advocate. As a guide:

Magistrates are addressed as “Sir” or “Madam” (or "your worship" in Northern Ireland)

The Chairman of the RCVS Disciplinary Committee is addressed as “Sir” or “Madam”

County Court judges are addressed as “Your Honour”

High Court and Appeal Court judges, Scottish Sheriffs and Court of Session judges are addressed as “My Lord” or “My Lady” or “Your Lordship/Ladyship”

What happens when you are in the witness box?

22.43 The court usher (clerk in Northern Ireland) will ask you whether you wish to swear or affirm. This relates to the evidence that you will be giving making it “sworn evidence” or “affirmed evidence”. Save for Scotland, where the choice is either to swear on the Holy Bible or to affirm, you will be asked the holy book on which you want to swear. The court usher has copies of the holy books of the main faiths. You will then be asked to read the oath (or affirmation) off the card handed to you.

22.44 You will be asked to state your name and professional address and your professional qualifications and experience. In the case of a civil trial you will be taken to a copy of your sworn statement (or, for expert witnesses, their report) usually they are in a bundle of documents called the trial bundle, a copy of which will be provided in the witness box and you will be asked to

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confirm the contents of your statement/report as your evidence. If you have any corrections to your statement which you want to make, this is the time to do so.

22.45 You are then likely to be subject to examination in chief (criminal trial only except Northern Ireland) when the advocate will put to you questions to support his/her case. When being asked questions it is important to listen to, and answer, the question that is asked. Answers should be directed towards the Judge/Magistrate/Chairman/Jury (not the lawyer who is asking the questions) and should be given slowly and clearly enough to permit a written note to be taken. A commonly used guide is to watch the judge’s pen – when the judge stops writing, it is time to continue speaking. You should answer the questions as fully as you need to, but no more, bearing in mind that the advocate cannot ask you leading questions. Use simple, non-technical language. If you have to give a technical answer, explain it. If you do not understand the question, you should ask for clarification. If you do not know the answer to a question you should simply say so.

22.46 In civil cases your witness statement will usually stand as your examination in chief (except in Scotland where there is no general practice of lodging witness statements and the evidence of witnesses will be taken by examination in chief (as outlined above) unless previously taken by commission (see paragraph 4 above). Expert reports in Scottish civil cases are usually lodged with the court and available to all parties prior to the proof (civil trial) hearing. However an expert is still required to speak to their report and will be examined in chief on this. Lodging of reports is not obligatory and, on occasion, an expert will give evidence without being able to make reference to his report.

22.47 You may then be subject to cross examination (in both criminal and civil trials), which is when the advocate for the opposing side will put questions to you. He or she must give you an opportunity to comment on anything in his/her client's case which differs materially from your evidence ie 'put his case'. He or she may ask you questions about matters that you have not covered in your evidence, but which assist his/her client's case. He/she may also try to further his/her client's case by casting doubt on the validity or accuracy of your evidence. It is important to remain professional when responding to cross examination. You should not allow yourself to become angry or upset with the advocate’s questioning, they are simply carrying out their role which is to test their opponent’s case by cross examination. It is also important to be precise but complete in your answers. For example, if you are asked whether a particular scenario or outcome is possible, and in your view it is, but unlikely, then you should give the complete answer, and not merely answer “Yes”.

22.48 After cross examination there may be re-examination by the advocate acting for ‘your side’. This does not always happen and is usually used to clarify aspects of what has been said during cross examination.

22.49 At any time the judge or Chairman may also ask questions, and when he/she does so will invite the advocate to ask further questions if they wish to do so, arising out of the judge’s question.

Remuneration levels for witnesses

22.50 The RCVS does not usually offer guidance as to remuneration levels, unless the fees charged are so high as to risk bringing the profession into disrepute. The RCVS recommends discussion with others working in the field to establish the reasonable ‘going rate’ for expert witness work in any particular field or area of practice. Generally, witnesses of fact are entitled to expenses, including loss of earnings. In Northern Ireland, witnesses of fact are not paid a professional fee for attending court. In Scotland, any loss of earnings are paid net of tax and National Insurance.

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Other tribunals

22.51 The principles outlined in this annex are applicable to tribunals and arbitrations and veterinary surgeons and veterinary nurses acting as witnesses are not immune from prosecution or disciplinary proceedings.

Further information

22.52 The following organisations offer further information and advice:

a. Veterinary Defence Society www.veterinarydefencesociety.co.uk b. Society of Practising Veterinary Surgeons www.spvs.org.uk c. British Veterinary Association www.bva.co.uk d. British Equine Veterinary Association www.beva.org.uk e. Veterinary Association for Arbitration and

Jurisprudencewww.veterinaryexpertwitnesses.co.uk f. Veterinary Benevolent Fund www.vbf.org.uk g. BVA Legal Advice Helpline (for BVA members) www.bva.co.uk

Lists of experts

22.53 The following organisations offer lists of expert witnesses:

a. Council for the Registration of Forensic Practitioners www.crfp.org.uk b. UK Register of Expert Witnesses www.jspubs.com c. The Law Society Directory of Expert Witnesses www.sweetandmaxwell.co.uk d. The Expert Witness Institute www.ewi.org.uk e. Academy of Experts www.academy-experts.org f. The Society of Expert Witnesses www.sew.org.uk g. The-Expert-Witness.co.uk www.the-expert-witness.co.uk h. The Law Society of England and Wales www.lawsociety.org.uk i. The Ministry of Justice www.justice.gov.uk j. Civil Justice Council www.judiciary.gov.uk/about-the-judiciary/advisory-bodies/cjc Reference books

22.54 The following reference book provides further information:

a. J.E. Cooper and M.E. Cooper, Introduction to Veterinary and Comparative Forensic Medicine, Blackwell Publishing, 2007, ISBN-10:1405111011

Other useful links

22.55 The following organisations provide further information:

a. Royal Society for the Prevention of Cruelty to Animals www.rspca.org.uk b. Scottish Society for the Prevention of Cruelty to Animals www.scottishspca.org c. The Scottish Courts Website www.scotcourts.gov.uk/ d. Witnesses in Scotland Website www.witnessesinscotland.com

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http://www.veterinarydefencesociety.co.uk/

http://www.spvs.org.uk/

http://www.bva.co.uk/

http://www.beva.org.uk/

http://www.veterinaryexpertwitnesses.co.uk/

http://www.vbf.org.uk/

http://www.bva.co.uk/

http://www.crfp.org.uk/

http://www.jspubs.com/

http://www.sweetandmaxwell.co.uk/

http://www.ewi.org.uk/

http://www.academy-experts.org/

http://www.sew.org.uk/

http://www.the-expert-witness.co.uk/

http://www.lawsociety.org.uk/

http://www.justice.gov.uk/

http://www.judiciary.gov.uk/about-the-judiciary/advisory-bodies/cjc

http://www.rspca.org.uk/

http://www.scottishspca.org/

http://www.scotcourts.gov.uk/

http://www.witnessesinscotland.com/

SC Apr 16 AI 03(d)


Date 27 April 2016

Title Feline renal transplants – approval of new guidance


Summary On 3 March 2016, RCVS Council was asked to consider the legal and ethical issues around feline renal transplants. At the conclusion of the meeting, it was agreed that the views of Council would be fed back to the Standards Committee with a view to agreeing some brief guidance at its next meeting in April.

Decisions required Standards Committee is asked:

a. To consider and approve new guidance on transplants and ethical sourcing, with any revisions / amendments as necessary.

b. To approve minor updates to the remainder of Chapter 27

Attachments Annex A: Extract from RCVS Council

Annex B: Revised Supporting Guidance Chapter 27


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Feline renal transplants – approval of new guidance 1. On 3 March 2016, RCVS Council was asked to consider the legal and ethical issues around feline

renal transplants. This included consideration of detailed written material including the report of the Science Advisory Panel, the legal opinion and the written views of the Standards Committee. Copies of those papers are not attached here as these have been considered in detail by the Standards Committee during previous meetings. To recap on the outcome, a copy of the Council minutes is attached at Annex A.

2. To summarise briefly, RCVS Council accepted the recommendation of the SAP that the College should not support the use of living source donors for feline renal transplantation. Many of the arguments raised in support correlated with the views of the Science Advisory Panel that it is contrary to a basic tenet of veterinary practice that inflicting pain and discomfort on an animal can only be justified as an act of veterinary surgery if it is for the benefit of the animal receiving that pain and discomfort.

3. On the subject of pre-euthanasia donors, Council noted that the Standards Committee did not

accept the Science Advisory Panel recommendation that there are no scientific or ethical reasons for the College not to permit, with suitable safeguards, renal transplantation from pre-euthanasia cats. It was acknowledged that the pre-euthanasia donor is still a living source donor. As such, from a legal perspective, to remove a kidney from a pre-euthanasia donor could be an unnecessary mutilation in certain UK jurisdictions; a criminal offence. There was general consensus that transplantation from pre-euthanasia donors was not acceptable and that only dead animals should be used as donors.

4. At the conclusion of the meeting, it was agreed that the views of Council would be fed back to the

Standards Committee with a view to agreeing some brief guidance on transplants at its next meeting in April.

5. Draft guidance has now been prepared and is attached at Annex B. This incorporates the key

points from the Council discussion and provides a brief summary of the current position for the profession. Standards Committee is asked to consider and approve the draft guidance, with any revisions / amendments, as necessary.

6. The renal transplants advice currently sits in Chapter 27 ‘Miscellaneous’. We have also taken this

opportunity to update the chapter more generally and to improve the overall structure and format of the guidance. There are no substantive changes, but some new text has been introduced to highlight the purpose of this chapter and to improve overall readability. Given the content, we have also renamed the chapter from ‘Miscellaneous’ to ‘Miscellaneous procedures: legal and ethical considerations’. Standards Committee is asked to approve these additional amendments to the chapter.

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SC Apr 16 AI 03(d) Annex A

Extract from Council Minutes (March 2016)

Feline Renal Transplants

1. Mr Catlow introduced the paper, thanking Natalie Heppenstall for her excellent work in preparing the report of the evidence gathering session and Lord Trees for the report of the Science Advisory Panel (SAP). Mr Catlow explained that the Standards Committee had considered the legal and ethical issues around feline renal transplants, but did not feel in a position to make a recommendation at this time as to a direction of travel and could only recommend that the issue is referred to Council for further consideration and debate.

2. In summary, the following matters were discussed by Council: a. The use of living source donors: Council noted that the Standards Committee debated the

issue at length and accepted the conclusion of the SAP that the College should not support the use of living source donors for feline renal transplantation. Overall, this view was endorsed by Council. One member commented that in his view the College’s original decision to proceed with the guidance in 2003 despite the risks had been disappointing and that the key issue remains the welfare of the source animal (it was suggested that the term ‘donor’ may not be the most appropriate word in the circumstances’).

b. Pre-euthanasia donors: Council also noted that the Standards Committee did not accept the SAP recommendation that there are no scientific or ethical reasons for the College not to permit, with suitable safeguards, renal transplantation from pre-euthanasia cats. There was discussion about the ‘pre-euthanasia’ donor. It was acknowledged that the pre-euthanasia donor is still a living source donor. As such, from a legal perspective, to remove a kidney from a pre-euthanasia donor could be an unnecessary mutilation in certain UK jurisdictions; a criminal offence. One member noted that while scientific advancement is important, animal welfare must take precedent. Overall, there was a general consensus within Council that pre-euthanasia feline renal transplantation is not acceptable and that only dead animals should be used as donors.

c. Sourcing animals: Council considered and shared concerns expressed by the Standards Committee regarding the sourcing of the pre-euthanasia donor, specifically the issues around ensuring the impartiality/detachment of the decision to euthanase from the decision to transplant, the notion of perverse human behaviour and the need for any safeguards and assurances to prevent the manufacturing of euthanasia situations. Concerns were also raised about the health and welfare of the pre-euthanasia donor in the gap between the decision to euthanase and the act itself and the issue of delay while efforts are made to find a recipient, as well as in any transporting.

d. Public opinion: One member highlighted that public opinion is also relevant and questioned

whether there is really a demand or appetite for renal transplants in the UK. It was noted that the Recognised Veterinary Practice Sub Committee has not received any applications relating to renal transplants. Issues concerning the quality of life for the recipient and ongoing costs implications for the owners were also highlighted.

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SC Apr 16 AI 03(d) Annex A

e. Other forms of transplants: There was discussion of transplants more generally. One member raised the issue of corneal transplantation, but it was noted that corneas are taken from dead donors. Another member urged the Committee to consider the impact that any decision may have on other types of tissue or organ donations, including in different species, as well as trying to ensure that any guidance is as ‘future-proofed’ as possible so that it can remain adaptable to any future changes in veterinary science and technology.

3. Overall, Council endorsed the recommendations of the SAP and the Standards Committee that

the RCVS should not support the use of living source donors for feline renal transplantation. There was also a general consensus that transplantation from pre-euthanasia donors was not acceptable and that only dead animals should be used as donors. It was agreed that these comments would be fed back to the Standards Committee with a view to agreeing some brief guidance at its next meeting in April.

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SC Apr 16 AI 03(d) Annex B

Draft revised guidance - New text in red

- Deleted text in strikethrough

- Text highlighted in green will be moved across to Chapter 25 Recognised Veterinary Practice

as it seems to sit more comfortably in that section.

- Paragraphs 27.1 to 27.1 have been approved by the Committee previously but have been moved from Chapter 2 as they seem to sit more comfortably in Chapter 27

27. Miscellaneous procedures: legal and ethical considerations Introduction

27.1 From time to time, veterinary surgeons and veterinary nurses may be asked to carry out procedures on animals which may not have a legal basis in the UK (e.g. purely cosmetic procedures or procedures sought for the sole convenience of the owner). Veterinary surgeons and veterinary nurses should be aware that UK animal welfare legislation legally restricts mutilations to animals (i.e. procedures which interfere with sensitive tissue or bone structure) unless they are carried out for the purposes of medical treatment:

a. In England and Wales, the Animal Welfare Act 2006 prohibits mutilations “otherwise than for the purpose of its medical treatment” or permitted by specific regulations (Section 5).

b. In Scotland, the Animal Health and Welfare (Scotland) Act 2006 prohibits mutilations except “where they are carried out for the purpose of the medical treatment of an animal” or permitted by specific regulations (Section 20).

c. The Welfare of Animals (Northern Ireland) Act 2011 provides that a prohibited procedure is one which involves interference with the sensitive tissues or bone structure of the animal, except in relation to (i) any procedure carried out by a veterinary surgeon; (ii) any procedure carried out for the diagnosis of disease; (iii) any procedure carried out for the purposes of medical treatment of an animal; (iv) any other procedure which is specified in regulations made by the Department (Section 5).

27.2 There are some procedures which are technically mutilations, but these are exempt from the ban due to reasons such as long-term welfare or animal management benefits, control of reproduction or identification purposes. These procedures are listed in the regulations for the relevant UK jurisdiction:

a. the Mutilations (Permitted Procedures) (England) Regulations 2007 b. the Mutilations (Permitted Procedures) (Wales) Regulations 2007 c. the Prohibited Procedures on Protected Animals (Exemptions) (Scotland) Regulations 2007 d. the Welfare of Animals (Permitted Procedures By Lay Persons) Regulations (Northern Ireland)

2012

27.3 These regulations also include additional requirements on how the various procedures should be performed (for example, requiring the administration of an anaesthetic, specifying the required age for an animal or setting down husbandry or conservation requirements).

27.4 Veterinary surgeons and veterinary nurses asked to perform procedures, which they consider may not have a legal basis, should consult the regulations and seek advice from the RCVS where necessary.

27.5 Below are some examples of the types of procedures / mutilations, which veterinary surgeons or veterinary nurses may be asked to consider in practice. Please note that this is not an exhaustive list, but includes some of the common topics.

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Tail docking (dogs) Veterinary Surgeons Act 1966 27.6 The removal of the whole or part of a dog’s tail amounts to the practice of veterinary surgery and therefore can, as a general rule, only be carried out by a veterinary surgeon.

27.7The Veterinary Surgeons Act applies to the United Kingdom (England, Wales, Scotland and Northern Ireland).

Animal Welfare Act 2006

27.8In England and Wales, Section 6 of the Animal Welfare Act 2006 makes it an offence to remove the whole of part of a dog's tail other than for the purpose of medical treatment, subject to the exemption for docking the tails of certain working dogs. In particular, the legislation provides: a. that any veterinary surgeon who docks a tail must certify that s/he has seen specified evidence that

the dog is likely to work in specified areas and that the dog is of a specified type; b. the dog must be no older than five days when docked and will also need to be microchipped before it

is three months old; 27.9In England, the Docking of Working Dogs' Tails (England) Regulations 2007 (SI 2007/1120) specify the certification requirements for veterinary surgeons docking working dogs’ tails (the form of words for the docking certificate can be found on The National Archives website). In particular, the Regulations specify: a. the types of dog that may be docked namely hunt point retrieve breeds of any type of combination of

types, spaniels of any type of combination of types or terriers of any type of combination of types; b. the types of evidence which the veterinary surgeon will need to see; c. identification and microchipping requirements. 27.10 In Wales, the Docking of Working Dogs' Tails (Wales) Regulations 2007 (SI 2007/1028 (W.95)) are similar to those which apply in England but not identical (information about the certification required is available on the Welsh Assembly website). In particular, the regulations specify: a. the types of dog which may be docked are more narrowly defined in Schedule 2 Part 1 of the

Regulations; b. the certificate which must be completed by both veterinary surgeon and client requires the client to

specify the breed of the dog and its dam, and the veterinary surgeon must be satisfied that the dog and its dam are of the stated;

c. the certificate must specify the purpose for which the dog is likely to be used and confirm that evidence relevant to the particular case has been produced.

Animal Health and Welfare (Scotland) Act 2006 27.11 In Scotland, Section 20 of the Animal Health and Welfare (Scotland) Act 2006 prohibits the mutilation of animals and there are no exemptions in any regulations for the non-therapeutic docking of dog’s tails. It is also an offence to take a dog from Scotland for the purpose of having its tail docked.

Welfare of Animals Act (Northern Ireland) 2011 27.12 In Northern Ireland, Section 6 of the Welfare of Animals Act (Northern Ireland) Act 2011 provides that a person does not commit an offence if the whole or any part of a dog’s tail is removed by a veterinary surgeon for the purpose of medical treatment; or in order to prevent or remove an immediate danger to the life of the dog in circumstances where it is not reasonably practicable to have the tail, or as the case may be, any part of the tail, removed by a veterinary surgeon.

27.13 There are also exemptions for docking the tails of certain working dogs. In particular, the legislation provides:

a. that any veterinary surgeon who docks a tail must certify that s/he has seen specified evidence that the dog is likely to be used for a specified type of work and that the dog is of a specified type;

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http://webarchive.nationalarchives.gov.uk/*/http:/archive.defra.gov.uk/foodfarm/farmanimal/welfare/act/documents/docking_certificate.pdf

http://wales.gov.uk/topics/environmentcountryside/ahw/animalwelfare/pets/dogs/dockingofworkingdogstails/?lang=en


b. the dog must be no older than 5 days when docked and will also need to be microchipped before it is 8 weeks old at the same veterinary practice that carried out the docking procedure.

27.14 The Welfare of Animals (Docking of Working Dogs’ Tails and Miscellaneous Amendments) Regulations (Northern Ireland) 2012 (NISR 2012/387) set out the certification process for the exemption for future working dogs, which must be completed by the breeder and the veterinary surgeon at the time the dog’s tail is docked and subsequently microchipped. The docking certificate can be found on the NI Direct website at:www.nidirect.gov.uk/tail-docking-dogs. 27.15 There will also be evidence which must be presented to the veterinary surgeon to allow him/her to decide if the pup meets the conditions to qualify as a potential future working dog. The pup and its dam must be presented to the veterinary surgeon within five days of the birth of the pup. If the dam has died since whelping, the veterinary surgeon must see veterinary certification to this effect. In particular, the Regulations specify:

a. the types of dog that may be docked namely hunt point retrieve breeds of any type or combination of types, spaniels of any type or combination of spaniel, or terriers of any type or combination of terrier;

b. the types of evidence that the veterinary surgeon will need to see; c. identification and microchipping requirements.

(Please note that the NI Direct link above also provides detailed information on the types of work and the evidential requirements)

Further information

27.16 Further guidance on the practical and legal approach to the docked puppy has been provided on the British Veterinary Association Animal Welfare Foundation website for both members and non-members. Removal of dew claws Veterinary Surgeons Act 1966 27.17 The removal of dew claws amounts to the practice of veterinary surgery and therefore can, as a general rule, only be carried out by a veterinary surgeon. Schedule 3 to the Veterinary Surgeons Act 1966, however, allows anyone of or over the age of 18 to amputate the dew claws of a dog, before its eyes are open.

27.18 The Veterinary Surgeons Act applies to the United Kingdom (England, Wales, Scotland and Northern Ireland).

Animal Welfare Act 2006 27.19 In England, Schedules 1 and 9 to the Mutilations (Permitted Procedures) (England) Regulations 2007 (SI 2007/1100) state that the removal of dew claws is a permitted procedure with the condition that ‘an anaesthetic must be administered except where the dog is a puppy whose eyes have not yet opened’.

27.20 In Wales, Schedules 1 and 9 to the Mutilations (Permitted Procedures) (Wales) Regulations 2007 (WSI 2007/1029) state that the removal of dew claws is a permitted procedure with the condition that ‘an anaesthetic must be administered except where the dog is a puppy whose eyes have not yet opened’

Animal Health and Welfare (Scotland) Act 2006 27.21 In Scotland, Schedule 9 of the Prohibited Procedures on Protected Animals (Exemptions) (Scotland) Regulations 2007 (SSI 2007/256) states that the amputation of dew claws is an exempted procedure and may be carried out for the purpose of general animal management. The Protection of Animals (Anaesthetic) Act 1954 continues to apply in Scotland and provides that anaesthetic must be administered except for ‘the amputation of the dew claws of a dog before its eyes are open’.

Welfare of Animals Act (Northern Ireland) 2011 27.22 In Northern Ireland, Schedule 8 of the Welfare of Animals (Permitted Procedures by Lay Persons) Regulations (Northern Ireland) 2012 (NISR 2012/153) states that the removal of the dew claws of dogs is a permitted procedure which may be carried out as a management procedure by lay persons but may only be carried out before the pups eyes are open. Otherwise, the removal of the dew claws of dogs is a prohibited procedure and may only be carried out by a veterinary surgeon.

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http://www.nidirect.gov.uk/tail-docking-dogs

http://www.bva-awf.org.uk/


What are a dog’s dew claws?

27.23 Colloquially, dew claw refers to the first digit on the hind limb and the first digit on the fore limb.

27.24 Anatomically, the dew claw is defined as the first digit of the hind limb. Dew claws (hind limb) are very variable in their occurrence, ranging from complete absence to a fully formed digit with skeletal components; most consist of a nail, skin and connective tissue with no skeletal articulation. Such a vestigial structure is certainly very vulnerable to damage through catching on vegetation; therefore, there is a good argument for removal of dew claws before five days of age.

27.25 Anatomically, the first digit of the fore limb is not a dew claw. Generally, the first digit of the fore limb is fully formed and has an important function. Not surprisingly dogs are often seen to use these ' thumbs ' exactly as you would expect -- to help grasp food and other objects because they can be adducted, flexed or extended like any other digit, due to the bony articulation and the muscle attachments.

27.26 Legislation has not defined dew claws and ultimately, it is for the courts to decide the meaning of dew claws applying to any specific legislation.

Conclusion 27.27 The removal of the first digit of the hind limb (true dew claws) is justified in most circumstances.

27.28 The removal of first digit of the fore limb is justified only if, in the veterinary surgeon’s professional opinion, the particular anatomy/appearance of the digits invites possible damage.

Canine surgical artificial insemination 27.29 Surgical Artificial Insemination (AI) carries many disadvantages for the bitch and is unlikely to be carried out in the best interests of any particular dog, but a veterinary surgeon may carry out surgical AI:

a. in the rare circumstances where Transcervical Insemination (TCI) has been demonstrated not to be a practical option

AND

b. the invasive nature of surgical AI is justified* and accompanied by an appropriate regime of post-operative pain relief.

* Veterinary surgeons are advised that on the information available to the Advisory Committee, surgical AI is justified only for exceptional reasons, for example, the incorporation of new genetic traits into a line or breed when the sire is not easily available or unable to mate naturally for reasons other than inherited disease.

27.30 When carrying out surgical AI, a veterinary surgeon should record in the bitch’s clinical records why TCI is not a practical option and the justification for the invasive procedure.

Prosthetic testicles 27.31 The RCVS has decided the insertion of prosthetic testicles is not a procedure that benefits the animal and is not in the animal’s interests. There is also concern that the procedure allows an owner to claim an animal with a prosthetic testicle had the natural conformation.

27.32 The RCVS advice is that the procedure is unethical.

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New technology tests Veterinary surgeons or veterinary nurses involved with the use of tests using genomic or other similar new technology (including proteomic and metabolite technology) within the context of ‘recognised veterinary practice’, are subject to the same restrictions, safeguards and guidance as those involved with tests using biochemical or other technology, such as:

a. compliance with the Veterinary Surgeons Act 1966, to ensure that , subject to the specified exemptions in the Act and subordinate legislation, only veterinary surgeons practise veterinary surgery;

b. consideration of the RCVS Code of Conduct the interface between the Veterinary Surgeons Act and the Animals (Scientific Procedures) Act 1986;

c. consideration of the published information on the clinical benefits of the test, particularly if the test is new;

d. consideration of the test as predictive or diagnostic; e. consideration of the specificity and sensitivity of the test; f. consideration of positive and negative predictive values; g. consideration of the environmental or other factors when the test relates to a complex condition; h. publicity is legal, decent, honest and truthful and therefore with no misleading claims; i. publicity is of a professional nature; j. consideration of responsibilities to patients and clients, such as informed consent from the client and,

if appropriate, informed consent for the use of any excess collected with a sample and not used in the test;

k. appropriate professional guidance and advice when test results are communicated to clients; and, l. consideration of responsibilities to the general public, including the use of professional status to

provide only factual information to the general public about veterinary products and services and the need for cooperation with colleagues and other health care professionals when appropriate.

The usual safeguards should be applied, as appropriate, even if the genomic or other test provides no diagnosis of disease. For example, such information may be used for breeding purposes or by insurance companies and may have a significant effect on the welfare of the animal or animals tested. Client confidentiality will apply to the results of such tests.

Renal transplantation (cats) NOTE: This guidance has been suspended pending a review. Please contact the Professional Conduct Department for advice (020 7202 0789 [email protected]). Introduction 27.21 The purpose of this supporting guidance is to safeguard the position of source and recipient animals involved in transplant procedures. It is the involvement of source animals which makes transplant procedures uniquely different in ethical terms from any other procedures.

27.22 This guidance is intended to apply in the first instance only to kidney transplants in cats, as this is the only procedure likely to be seriously contemplated in the United Kingdom in the immediate future, and will be reviewed regularly.

27.23 The RCVS takes the view that the transplantation of kidneys in cats should be regarded as ethically acceptable in the United Kingdom, but only if carried out in accordance with the guidelines set out below. In devising these guidelines it has deliberately set high standards which must be attained before transplants can be undertaken in the United Kingdom.

27.24 The RCVS accepts that only a few veterinary surgeons may choose to carry out this procedure.

27.25 The Home Office has accepted that kidney transplants in cats can be 'recognised veterinary practice' and, as such, exempt from the need for a Home Office licence under the Animals (Scientific Procedures) Act 1986. This is supported by Counsel's opinion sought jointly by the RCVS, the British Small Animal Veterinary Association and the Royal Society for the Prevention of Cruelty to Animals (RSPCA), (the "Legal Opinion").

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27.26 The RSPCA has indicated that the removal of a major organ from a living source animal might constitute an offence under the Protection of Animals Act 1911 and this possibility is supported by the Legal Opinion. However, the RSPCA has indicated that the degree to which this RCVS advice is followed will "influence any decision the RSPCA might take in considering the likelihood of a prosecution relating to organ transplantation between animals."

Part A: Ethical sourcing 27.27 All source animals must be treated with compassion and respect.

27.28 Organs for transplantation should not be commercially produced for the purpose; source animals should not be bred or bought for the purpose of transplantation.

27.29 The responsibility to provide a suitable source animal should normally be for the transplantation centre.

Part B: Balancing the interests of the source and recipient animals 27.30 Transplantation centres must give equal consideration to the interests of the source and recipient animals in deciding whether it is appropriate to proceed.

27.31 Source animals should be assessed for adequate renal function. In every case there must be the necessary compatibility between the source animal and the potential recipient animal. The level of distress caused to the source animal should be kept to a minimum. Source animals should be used on only one occasion.

27.32 In the event that the source animal is to be adopted or is already owned, then the owner or future owner needs to be fully informed of the procedure and any possible long term implications to the source animal. The owner of the recipient animal must be informed of the potential outcomes for the recipient animal. Owners must give informed consent to all procedures, which should be confirmed in writing.

27.33 Source animals should only be euthanased when there is no reasonable alternative.

Part C: Transplant centres 27.34 Centres intending to carry out transplantation procedures must meet the following requirements:

27.35 To safeguard both the source and recipient animals, there must be a suitably qualified team of veterinary surgeons to remove and implant the organ and to provide the necessary post-operative support, both to the source and recipient animals. The team should include veterinary surgeons with Diplomate or Board Certified Level qualifications in Medicine, Soft Tissue Surgery and Anaesthesia and qualifications or experience in microvascular surgery and critical care. Ideally, at least one member of the team should have first hand experience of transplant surgery at another centre over a period of time.

27.36 To safeguard the ongoing care of the recipient and source animals, the centre must ensure satisfactory arrangements for long-term care, as determined by the group specified in paragraph 27.35. In particular, before carrying out transplantation procedures the centre must:

a. provide the recipient's primary practice with aftercare guidelines; and b. ensure that the veterinary surgeon(s) from the primary practice are willing and able to undertake this

aftercare. 27.37 Approved centres will be expected to be up to date with current developments that significantly improve outcomes, keep appropriate records of the transplantations carried out and undertake regular audit of clinical outcomes.

27.38 The centre must have an Ethics Committee to ensure that all procedures are subject to rigorous and critical review. This Committee should include lay representation and must represent the health and welfare interests of both source and recipient animals and the views of staff involved.

Inspection 27.39 Centres seeking formal confirmation that they meet the requirements above may ask RCVS to appoint an Inspector for the purpose. The costs of the inspection are to be borne by the Centre seeking approval.

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Feline renal and other transplantation procedures and ethical sourcing

Please note that the following guidance on feline renal transplantation was introduced in XX 2016 following a legal and ethical review by the RCVS of previous guidance on this subject. That previous guidance was suspended in 2013 and has now been formally withdrawn and replaced with the following paragraphs.

27.33 The RCVS does not support the use of living source donors for feline renal transplantation. This is contrary to a basic tenet of veterinary practice that inflicting pain and discomfort on an animal can only be justified as an act of veterinary surgery if it is for the benefit of the animal receiving that pain and discomfort. This advice also extends to other forms of transplantation.

27.34 The RCVS does not support feline renal transplantation from pre-euthanasia donors. This is because pre-euthanasia donors are still living source donors. Additionally, from a legal perspective, to remove a kidney from a pre-euthanasia donor could be a considered a prohibited mutilation in certain UK jurisdictions; a criminal offence. This advice extends to other types of transplantations from pre-euthanasia donors.

27.35 The RCVS does not, in principle, oppose the use of the dead animals as donors for transplantation procedures (i.e. where the tissue is taken from animal patients post-euthanasia only). In some cases, cadavers or tissue may also be donated for the purpose of scientific research or the advancement of veterinary education.

[Standards Committee – should we refer to examples such as corneas from dead donors or tissue donation such as bone, tendon and ligament as carried out by the Veterinary Tissue Bank (see http://vtbank.org/ - or is this too specific for guidance and what about future-proofing?)

27.36 Cadavers and tissues should be ethically sourced. In the opinion of the RCVS this means that cadavers and tissues will have been obtained from animals that have died from natural causes, medically untreatable illnesses, or in accidents, or from those animals that have been euthanased secondary to terminal disease or illness or non-recoverable injury, or where owners have consented to euthanasia on financial or other grounds. Animals that have been bought or bred solely to provide cadavers and tissue are not generally considered to be ethically sourced.

27.37 Veterinary surgeons involved in such procedures should ensure that decisions on euthanasia are made on clinical grounds and they should ensure that cadavers and/or tissues are ethically sourced. Decisions relating to donation should not be directly linked to the decision to euthanise.

27.38 Veterinary surgeons should seek informed consent from the client for the use of their animal’s body or tissue. It is advisable for consent to be obtained in writing. Given the sensitive and emotional nature of the subject it may not be appropriate for veterinary surgeons to offer or discuss donation as an option with every client. Clients should not be unduly pressurised into proceeding and should be given sufficient information to make an informed choice. Veterinary surgeons should make sure that clients have sufficient time to ask questions and to make decisions.

27.39 It may be helpful to discuss general options for disposal at an early stage (i.e. when the client is not dealing with the stress at the time of the euthanasia). Appropriately and sensitively worded written information / leaflets can also assist in explaining disposal options to clients. Even if disposal options are discussed at an early stage, informed consent for any final decision should still be obtained.

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Blood transfusions 27.40 Section 2(8) of the Animals (Scientific Procedures) Act 1986 exempts procedures conducted as part of any recognised veterinary, agricultural or animal husbandry practice. Taking blood from healthy donors with the permission of the owner and with the intention of administering the blood or its products to a recipient is recognised veterinary practice where there is an immediate or anticipated clinical indication for the transfusion. Such a clinical procedure would be acceptable on the scale of an individual veterinary practice or between other practices in the locality. However, the collection of blood for the preparation of blood products on a larger commercial scale for general therapeutic use in animals may require licences under the Animals (Scientific Procedures) Act 1986; this larger commercial scale activity would need to be licensed under the Veterinary Medicines Regulations.

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Date 27 April 2016

Title Update on the review telemedicine and new technology tests


Summary This paper provides an update on the progress on the upcoming Standards Committee review of telemedicine and new technology tests.


Attachments Annex A: Skeleton outline and estimated costs (confidential)


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Update on the review of telemedicine and new technology

1. At its last meeting in January, Standards Committee expressed its desire to commence a ‘select

committee’ style evidence gathering exercise on the subject of telemedicine and new technology in 2016. The Chair indicated that the matter had been put on hold until 2017. This was because the Operational Board had looked at the College’s priorities for 2016 and decided that with all that was going on (including the new trial for the Ethics Review Panel and other initiatives) telemedicine could wait until the beginning of 2017. Council had also approved the 2016 list of priorities at its meeting in November 2015, which included the decision on telemedicine.

2. The clear mood within the Committee was that the plans to consider telemedicine could not wait until 2017 and must be progressed in the interests of staying ahead of any developments in an area that will have significant legal, ethical and regulatory implications. As such, we agreed to provide feedback to the Operational Board and to consider further how the review might be undertaken.

3. On 20 April 2016 Operational Board will be asked to consider a skeleton outline for the proposed

review – copy attached at Annex A. This has been drawn up based on the structure and format of the Standards Committee review of 24-hour emergency cover carried out in 2014. In brief, we anticipate that the review will involve six key phases, namely:

Phase 1: Initial scoping exercise and agreement of key consultation themes Phase 2: Public consultation (open for 6-8 weeks) Phase 3: Review of the written consultation responses Phase 4: Oral evidence gathering sessions Phase 5: Review of oral evidence and drafting of new Code / Guidance requirements Phase 6: Recommendations to RCVS Council

4. The estimated costs associated with the review have also been included in the attached proposal. These have been calculated based on the costs associated with the 24-hour emergency cover review. Operational Board will be asked to approve the funding for this work as set out in the attached document.

5. The majority of the costs to be incurred relate to the additional Committee meetings/ evidence

gathering sessions. The costs of an independent report writer (for the oral evidence sessions only) have also been included. It is hoped that evidence sessions can be held in-house so as to minimise venue / catering costs.

6. The 2014 review involved a significant amount of work on the part of the Advice Team in addition

to their usual responsibilities for other Standards Committee / Sub Committee work as well as day to day advice work. It is anticipated that this project will require a similar amount of work, but no additional resources are being requested.

7. If approved by the Board, we anticipate that the review will be launched before the end of 2016.

Further updates will be provided to the Standards Committee at its meeting on 27 April 2016.

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Date 27 April 2016

Title Disciplinary Committee Report


Summary Update of Disciplinary Committee since the last meeting of the Standards Committee on 27 January 2016


Attachments None

Author Chloe Newbold Clerk to the Disciplinary Committee Tel: 020 7202 0729 Email: [email protected]

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Report of Disciplinary Committee hearings since the Standards Committee meeting on 27 January 2016

Background

1. Since Council’s meeting on 5 November 2015, the Disciplinary Committee (‘the Committee’) has met on five occasions; the Veterinary Nurses’ Disciplinary Committee (‘VN DC’) has met on one occasion.

Hearings Dr Duncan Davidson 2. Between 18 and 22 January 2015, the Committee heard an inquiry into allegations raised against

Dr Duncan Davidson and his treatment of his client’s cat, Ameira, who was under his care. The allegations included:

- That Dr Davidson did not keep accurate, clear and detailed notes, and that those notes were

amended at a later date. - That Dr Davidson failed to provide adequate care to Ameira.

3. The full details of Charges are available on the RCVS website at

http://www.rcvs.org.uk/document-library/davidson-duncan-january-2016-charges

4. The Committee found charges 1 (i) and 2 (ii) proven, namely that Dr Davidson failed to provide any or any adequate analgesia to Ameira and administered corticosteroids when the same were either not indicated or were contraindicated; and a further two charges proved concerning Dr Davidson’s illegible and unclear clinical notes. However, the Committee found the remaining charges not proved stating ‘The Committee is satisfied that both Ms Hayat and Dr Davidson sought to assist it with their recollection of events. Where there are differences between their respective recollections, the Committee has concluded that they largely reflect the interpretation each has placed on the events. The Committee has found it difficult to reach a conclusion as to which account is correct.’

5. The Committee decided the charges proven did not amount to disgraceful conduct in a

professional respect and outlined that ‘it does not consider that individually or cumulatively the facts found proved fall far short of the conduct to be expected of a reasonably competent veterinary surgeon’ and, on this basis, the case was dismissed.

Mr Kirk Thompson

6. On 29 January 2016, the Committee met to hear an Inquiry into Mr Kirk Franklyn Thompson.

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7. The Charges brought by the College can be found at: http://www.rcvs.org.uk/document-library/thompson-kirk-january-2016-charges/

8. On 3 April 2014, Mr Thompson was sentenced to twelve months’ imprisonment for the offence of assault occasioning actual bodily harm; six months’ imprisonment for the possession of a controlled drug and an extended sentence under Section 226A of the Criminal Justice Act 2003 for manslaughter; comprising a custodial term of 10 years plus an extension period of 5 years. All sentences were to run concurrently.

9. At the time of hearing, Mr Thompson was imprisoned serving his 15 year sentence, he was not represented and he did not attend the hearing. Mr Thompson was given the opportunity to attend by video link which he refused. The Committee decided to continue in Mr Thompson’s absence, taking into account that the Notice of Inquiry was properly served and that it was in the interests of justice to proceed in his absence.

10. In his correspondence, previous to the hearing, Mr Thompson raised a question on the jurisdiction of the RCVS. On 30 March 2014, Mr Thompson’s name was removed from the College’s Register at his request. The College submitted that his name was removed in error and with reference to The Veterinary Surgeons and Veterinary Practitioners (Registrations) Order of Council 2010 (SI 2854/2010) (and the Regulations which replaced them (SI 3493/2014))1 the Registrar has discretion not to remove a registrant’s name whilst disciplinary proceedings are on-going and as such, Mr Thompson remained on the Register throughout the investigation into his fitness to practise.

11. The Committee were satisfied that Mr Thompson remained on the Register and was subject to the jurisdiction of the RCVS.

12. In relation to his conviction, the Committee stated ‘that Mr Thompson’s conduct is fundamentally incompatible with being a veterinary surgeon’ and that he was not fit to practise as a veterinary surgeon.

13. The only sanction the Committee viewed as proportionate to impose was the removal of Mr Thompson’s name from the College’s Register. The Committee’s full findings can be found at: https://www.rcvs.org.uk/document-library/thompson-kirk-january-2016-findings-of-fact-and-on-disgraceful/

Mr Dermot Costelloe 14. The Committee met to hear an Inquiry into Mr Dermot Costelloe’s conduct in his dealings with a

client and her dog, Scruffy. Mr Costelloe attended the hearing and he was represented.

15. The background to the case is the client’s dog, Scruffy, had been left in the overnight care of Tern Veterinary Group, of which Mr Costelloe was a Partner. Upon arrival at the surgery in the morning, Mr Costelloe was informed Scruffy had died overnight. Mr Costelloe spoke with the client and told her Scruffy was still alive but struggling to breathe. When his client insisted on coming into the

1 http://www.legislation.gov.uk/uksi/2014/3493/schedule/made

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http://www.rcvs.org.uk/document-library/thompson-kirk-january-2016-charges/

https://www.rcvs.org.uk/document-library/thompson-kirk-january-2016-findings-of-fact-and-on-disgraceful/

https://www.rcvs.org.uk/document-library/thompson-kirk-january-2016-findings-of-fact-and-on-disgraceful/

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practice, he called back two minutes later informing her Scruffy had died 5 minutes previous. Mr Costelloe then fabricated a hospitalisation sheet that gave the impression Scruffy had been monitored all night. Eventually Mr Costelle organised a meeting with the client and admitted his dishonesty. He explained he had been worried of her reaction to learning Scruffy had died and also for the reputation of his practice.

16. The Charges are available on the RCVS website: http://www.rcvs.org.uk/document-library/costelloe-dermot-february-2016-charges/

17. Mr Costelloe admitted all charges and the Committee concluded that the facts found proved amount to disgraceful conduct in a professional respect as it considered that Mr. Costelloe’s conduct fell far short of that which is expected of a member of the veterinary profession.

18. In coming to a decision on sanction the Committee had regard to the evident remorse, shame and insight shown by the Respondent. The Committee took the view that it is unlikely that he would ever repeat this sort of dishonest conduct in future.

19. On decision of sanction the Committee stated:

‘The Committee does not condone what the Respondent has done. It considers that the public interest requires that there has to be confidence that veterinary surgeons do not fabricate accounts or documents, no matter what their intentions. Nevertheless, the Committee considers that it should mark the seriousness of the Respondent’s dishonest conduct by a period of suspension.

The Committee has therefore determined that suspension for a period of 10 weeks is proportionate in all the circumstances to mark the nature and gravity of the case and is sufficient to maintain public confidence in the profession and to uphold proper standards of conduct and behaviour, and directs the Registrar accordingly.’

Mr Robert Alun Merfyn Evans 20. The Committee met on 11 February 2015 to hear an Inquiry into Mr Evans of Priory Vets in

Cardigan.

21. The College alleged that Mr Evans intentionally misled his business partner Mr Lewis, resulting in incorrect reporting of TB test results from cattle at his farm. In addition, he tested his own cattle and did not report the testing of these animals and failed to register the births and deaths of cattle on his farm. His actions appeared therefore to be dishonest and amounted to false certification.

22. The Charges can be found on the RCVS website: http://www.rcvs.org.uk/document-library/evans-

robert-alun-merfyn-february-2016-charges/

23. From the outset, Mr Evans admitted all charges against him and that they amounted to disgraceful misconduct in a professional respect.

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http://www.rcvs.org.uk/document-library/costelloe-dermot-february-2016-charges/

http://www.rcvs.org.uk/document-library/evans-robert-alun-merfyn-february-2016-charges/

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24. The Committee recognised that the charges stemmed from 2005 or 2006 when Mr Evans mislaid a batch of 9 bovine passport application forms sent to him for registering the birth of new cattle on his farm and he did not feel able to seek help online. Due to his hearing disabilities he also did not feel able to seek help from the relevant authorities on the telephone and he was too embarrassed to confess his mistake to his family or to his partners.

25. The offences came to light when a late return was made to the AHVLA in respect of a TB Test

Report for the animals on Mr Evans’ farm. The lateness of the return prompted more scrutiny than would otherwise have been given to the return. Investigations were instituted and Mr Evans immediately admitted what had happened.

26. Charges 2[a] and 2[b] have been the subject of criminal proceedings and on 14 October 2015 in

the Ceredigion and Pembrokeshire Magistrates Court, Mr Evans pleaded guilty to 14 offences of failing to register the births and deaths of cattle. He was given a conditional discharge for 18 months on all charges and ordered to pay costs of £1,000 and a victim surcharge of £15.

27. The Committee took the view that ‘the course of conduct on which he embarked and which has

led to these charges was the result of a simple mistake at a time of considerable stress to him. He was not guilty of deliberate misconduct at the outset but...what started as an innocent mistake took on a life of its own and led him into deliberate and dishonest misconduct because he did not know how to get himself out of the predicament he was in.’; and deciding on sanction that ‘the Respondent who is a man of good character has fully accepted his guilt, and has real insight into the seriousness of his conduct. He cooperated fully with the investigations with County Council who prosecuted him in the Magistrates, and with the College.’

28. The Committee were satisfied that Mr Evans had rectified his failings, his affairs are now in proper

order and this misconduct will not occur again. As a result, the Committee decided that Mr Evans should be suspended for a period of six months.

Mr Warwick Seymour-Hamilton

29. The Disciplinary Committee met on 18 March 2016 to hear an application for restoration to the RCVS Register from Mr Seymour-Hamilton.

30. On 13 June 1994 Mr Seymour-Hamilton was removed from the Register after being found guilty of disgraceful conduct in a professional respect. The Committee described the Applicant as showing a total disregard of basic hygiene and care for animals and was such as to bring the profession into disrepute.

31. On 24 July 1995 the Applicant made an application for restoration to the Register. He informed the Committee that since 1990, the combined effects of the recession and the strain of looking after his elderly mother had led to the situation in which his premises had been in the state described at the original hearing. The Committee refused the application after the Applicant accepted he had not taken any steps during his period off the register to update his knowledge and he had not undertaken any refurbishment of the premises as yet.

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32. On 18 June 2010, the Applicant made a second application for restoration to the Register. He gave evidence to the Committee to the effect that he had no intention of returning to clinical practice, but believed that restoration would improve his professional status by giving him more credibility. The Applicant accepted that in the previous fifteen years he had not undertaken any relevant Continuing Professional Development, had not visited any veterinary practices or read the College's Guide to Professional Conduct. The Committee refused the application.

33. On 5 January 2015 the Applicant made his third application for restoration to the Register. He outlined his wish is to be restored to the Register in order to widen his work and research to include animals, as well as humans. The Applicant acknowledged his lack of knowledge in respect of a number of areas to do with veterinary practice and its regulation explaining they were not relevant to his current work as a herbalist and naturopath. The Committee noted that this demonstrated a fundamental lack of understanding as to the Committee's function and its terms of reference on an application for restoration. The Committee dismissed the application.

34. On 4 January 2016, the Applicant notified the College by email that he wished to make a further application for restoration. He was reminded of the relevant Procedure and Evidence Rules 2004 and of the factors listed at paragraph 70 of the Disciplinary Committee Guidance. These factors can be found on the RCVS website at http://www.rcvs.org.uk/document-library/disciplinary-committee-procedure-guidance/

35. At the hearing, the Legal Assessor advised the Committee that the previous refusals for

restoration do not play a part in the current application and they were to make a decision on the merits of the case now before it.

36. The Applicant submitted supporting documentation for his application explaining his objective in seeking restoration is to secure funding or other support for his herbal remedies and research into herbal medicines.

37. The Committee refused the application for restoration stating:

“The Committee entirely understands the Applicant’s desire to advance his prospects of achieving acceptance amongst academics and practitioners of his research work and that those prospects might be enhanced by a restoration of his name to the Register but that is not a factor which is relevant to his Application for Restoration. This Committee’s obligations and duties are to see that the interests of animal welfare are properly protected by ensuring that only those who are properly trained, knowledgeable and experienced are permitted to treat animals and that public confidence in the standards of the profession are maintained. The risks attendant on a restoration of this Applicant to the Register are, in the judgement of this Committee, plain and obvious. Accordingly, this application is refused.”

38. The Committee’s full decision can be found at: http://www.rcvs.org.uk/document-library/seymour-hamilton-warwick-j-march-2016-decision-on-application/

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http://www.rcvs.org.uk/document-library/disciplinary-committee-procedure-guidance/

http://www.rcvs.org.uk/document-library/disciplinary-committee-procedure-guidance/

http://www.rcvs.org.uk/document-library/seymour-hamilton-warwick-j-march-2016-decision-on-application/

http://www.rcvs.org.uk/document-library/seymour-hamilton-warwick-j-march-2016-decision-on-application/

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Upcoming Hearings

39. There are currently two hearings listed before the Committee on the following dates:

• 09-16 May 2016 (for Inquiry) • 18-20 May 2016 (for Inquiry)

40. In addition to those set out above, there was a further Inquiry into a veterinary surgeon listed in

December; however this was postponed due to the respondent’s ill health. A new hearing date has not yet been set.

41. In addition to the cases already listed, one further case has been referred to the Committee for

inquiry. The Clerk will list these cases as soon as possible.

42. At present, there are no VN DC cases scheduled or awaiting listing. Appeals 43. No appeals have been heard since the last Standards Committee meeting.

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Date 27 April 2016

Title Riding Establishments Sub-Committee Report


Summary The Committee is asked to note an update on the work of the Riding Establishments Sub-Committee.


Attachments None

Author Laura McClintock

Standards and Advisory Manager / Solicitor

0207 202 0763

[email protected]

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Riding Establishments Sub-Committee Report

Defra consultation on the review of animal establishments licensing in England 1. Standards Committee is aware from previous update papers that Defra is currently reviewing the

various pieces of legislation which govern the licensing of animal establishments. To summarise briefly, local authorities are required by law to issue licences for specific animal-related establishments and activities, with the aim of maintaining good standards of animal welfare. There is a registration requirement for performing animals, and licensing systems for pet shops, animal boarding, riding establishments and dog breeding.

2. Defra is conducting a cross-cutting review of licences and permits and is seeking views on a number of proposed changes to the animal establishment licensing system. One proposal is to introduce new secondary legislation under the Animal Welfare Act 2006. This would introduce a single ‘Animal Establishment Licence’. The aim is to reduce administrative burdens in the licensing process and Defra has mooted the idea of allowing local authorities to grant three-year licences on a risk-based approach, and would welcome a greater role for UKAS-accredited organisations. The idea is that local authorities will be content to issue a licence to an establishment that has been inspected by a UKAS-accredited organisation.

3. The RCVS responded to the consultation, with the Riding Establishments Sub-Committee

contributing the following key points relevant to the regulation of riding establishments:

a. The RCVS has a current legislative responsibility for maintaining the official list of Riding Establishment Inspectors. The purpose of the list and associated regulatory regime is to maintain the competency of inspectors. The RCVS would like to request clarity on how the proposals will impact the existing List of Riding Establishment Inspectors and associated regime.

b. The RCVS believes that the proposed single licence is inappropriate, as there are significant differences between different animal establishments. An individual veterinary inspector might be competent to inspect one form of animal establishment but not another. The RCVS has particular concerns about the impact of the proposed single licence on the inspection of riding establishments given the animal welfare and public safety concerns associated with this activity.

c. Where other establishment inspection regimes are justified by animal welfare concerns alone,

the riding establishment inspection regime is further justified based on the public safety risks (in particular the risk to riders), therefore regular veterinary inspection is considered essential.

d. The proposals are therefore inadequate; any inspection regime and licence should continue to

be annual, rather than three-yearly as proposed here (the circumstances of riding establishments can change a great deal over the course of a three-year period, including changes in the horses stabled there and the management). A three-year licence would be insufficient to ensure continued animal welfare. More often than not, existing annual inspections of riding establishments identify issues that need to be remedied, and therefore there is value in preserving annual inspections.

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e. 18-monthly inspections may be acceptable, as these would facilitate the inspection of

establishments at different times of year, when differing standards may be required to maintain animal welfare.

f. We might also be comfortable accepting licensing for different periods depending on the results

of previous inspections, in effect, a risk-based approach. Riding establishments that have shown consistently good results could be licensed for longer periods than those where inspections have revealed problems.

g. It is currently difficult to revoke a riding establishment’s licence. If three-year licences are to be

introduced then revocation would need to be made easier in case problems arose in the interim period between inspections.

h. At present, the transfer of a licence from one establishment to another requires formal sign-off

from a veterinary surgeon. However under the new proposals transfer of a licence can be agreed by local government. The RCVS believes that this is inappropriate given the potential significance of any such change in proprietor and the ensuing implications for animal welfare and public safety.

Induction and refresher courses 2016

4. The Advice Team is currently in the process of organising the induction and refresher courses for

2016. These are held annually in two locations (Scotland and the South). New applicants must attend as well as existing inspectors, who must attend a refresher course every 5 years. This year the courses will be taking place on 29 June (Scotland) and 8 July (London).

5. The Advice Team is currently working with the Riding Establishments Sub-Committee to refresh and update the current format. The aim of the courses is to help inspectors make the judgments that the inspection process requires, and, wherever possible, inspectors want certainty that their judgment is aligned with that of their peers. The course will include training on the different types of riding establishments that inspectors are likely to come across (trekking centres, polo yards, beach donkeys) and the related issues they may have to deal with. The courses also cover key issues around what needs to be inspected; common problems and scenarios during an inspection; saddlery and tack; and, discussion of animal welfare and public safety aspects.

Advice queries 6. The Advice Team continues to receive a regular stream of enquiries from local authorities,

veterinary surgeon inspectors and occasionally the proprietors of riding establishments. Routine and straightforward queries will be answered by the Advice Team, but new issues and complex issues will be passed to the Chairman or the full Sub-Committee for consideration.

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Application of the Acts to non riding activities

7. One recent example enquiry related to the application of the Acts in relation to an operation that involves members of the public "petting" horses as therapy. In this case, there was no actual riding involved, but the Local Authority in question was keen for the operation to be inspected from a welfare / public safety point of view and sought the views of the Sub-Committee.

8. Advice was given that the term ‘riding establishment’ means the carrying on of a business “of

keeping horses to let them out on hire for riding, or for use in providing instruction in riding for payment, or both.”(RE Act 1964 S.6 (1)). This means that if there is no riding taking place, then the operation technically falls outside the scope of the Acts. However, given that activities of this nature can often change and expand to include riding, it can be helpful for the Local Authority to have an appreciation of what is actually taking place.

9. Another example is carriage driving. The Acts apply to horses for hire and instruction in riding; not

driving. However, over the years, we are aware that some Local Authorities have taken the view, that unless they are Hackney Carriages, it is better, on animal welfare terms that they are inspected. The Committee has not taken issue with Local Authorities, who choose to adopt this pragmatic approach on animal welfare grounds.

Inspection issues: terminology, clinical abnormalities and restrictions on use

10. The Committee also considered a recent query from a Local Authority relating to inspections. This included the use of the term “light work" in relation to restrictions on the use of the horses in the school. The Committee commented that the term is open to misinterpretation; however, it is an expression that is frequently used in practice and within the horse industry. The Committee commented that if the local authority needs a clearer guide for better understanding or they are concerned the school is failing to follow the advice of the inspector and overworking the animal concerned, a more precise recommendation should be made.

11. On a similar note, the Committee also considered a recent issue relating to the condition of the

horses in the school, specifically around eye abnormalities. The Act requires that paramount consideration will be given to the condition of the horses and that they will be maintained in good health and will be physically fit in all respects, and that in the case of a horse kept for the purpose of its being let out on hire for riding or for a horse kept for the purpose of its being used in providing instruction in riding the horse will be suitable for the purpose for which it is kept.

12. The Committee advised that when abnormalities are found they must be assessed in respect of the

animal’s welfare and the safety of its rider. The abnormality must be noted and a decision must be made immediately as to whether the animal should continue to be used. The owner or his agent should also be informed immediately. In such cases the inspector should not attempt to make a diagnosis or suggest treatment, but should inform the owner or manager that the horse must be seen by their own veterinary surgeon. If a horse is found to be in need of veterinary attention it must be removed from work by a verbal order that must be confirmed in writing as soon as possible

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at or after the inspection. Any such animal may only be returned to work when the owner has obtained, at his own expense, a veterinary certificate stating that the horse is fit for work.

Biennial inspections of riding establishments

13. A local authority recently sought our view on the issue of biennial inspections. The particular Local Authority’s preference is that riding establishments are inspected annually, but they have been dealing with one establishment that is trying to get two licences out of one report. The Sub-Committee highlighted that these issues have been discussed historically and bienniel inspections are outwith the spirit of the legislation. Inspections of riding establishments are carried out annually by a trained veterinary inspector appointed by the Local Authority to assure animal welfare and public safety. It is the strong belief of the RCVS's Riding Establishment’s Sub Committee that inspections of a greater interval than a year constitute a significant potential risk of compromising both animal welfare and public safety.

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