In the wake of concerns from the profession about the Chikosi decision the RCVS recently decided to review it's advice on emergency out of hours cover and commissioned some market research into the issue. On 5th June 2014, the Chair of the Standards Committee presented the Committee's recommendations to Council in a presentation which may be found here. The presentation refers to the Chikosi decision itself, and also to a petition raised by a veterinary surgeon, Jo Dyer, which received over 2,800 signatures; in my view this number reflects the fact that there is widespread concern amongst the members of the profession about their ability to meet their obligations as set out in the present Code of Conduct.

At the time of writing this blog my understanding is that the recommendation from the Standards Committee is not to change the Code but to change the Guidance that goes with the Code. The cynic would say that this was always likely to happen as the present chair of the Standards Committee is the same chair of the same committee that produced the present Code of Conduct which replaced the Guide to Professional Conduct preceding it: If you are an optimist and read the presentation you would probably find things in it to agree with and be tempted to describe the recommendations as the curate's egg...there is a recommendation for example to point out to keepers of animals that the responsibility for the welfare of the animal rests with them. But in its present form the Code still contains words that the man or woman in the street would interpret as a practising vet they happen to contact in what they consider to be an emergency having an obligation to provide out of hours emergency cover to them, possibly even out of hours domiciliary visits, even if they're not actually registered with the particular practice or veterinary organisation the vet on the spot at the time is working for. I have heard it said at the College that members of the public do read the Guidance...well they would wouldn't they if they were going to complain?

When you stand back from this situation and take a look at it from a view outside the veterinary world there is one thing that really stands out. If you want services in society you normally have to register for them. If you want dental cover you have to register; even if you want cover from a medical practice funded primarily by the National Health Service you have to register. It's certainly not normal to be able to expect service from a private healthcare business without having to register and even if you do register with a private healthcare business you cannot just demand services that business is not set up to provide.

Even beyond the healthcare arena it's normal to register. If you want benefits you register; if you want a bank account you register with that bank account. If you run up an overdraft facility with that bank then it costs you less if at the time of registering or re-registering for other services you pre-arrange that overdraft facility. On the internet it's common to turn up at a website and be given the option of going to the checkout straight away, or to register if you anticipate having an ongoing relationship with that business. Registering for services is so normal it is standard practice for many businesses and even for the general public who know that they have to register to avail themselves of them.

Registration is important to practices. It provides an opportunity for practises to plan the required resources to service the clients on their databases and it provides an opportunity for the owners or the keepers of the animals turning up at those practices to be prompted to consider whatever they have to do to adequately cater for their welfare, including the arrangements for emergency OOH cover or the availability of domiciliary [home or farm] visits or ambulatory services. It's difficult for some practices to provide domiciliary visits because they are not set up to do it; it can be difficult even for services to be provided out of normal working hours at the normal place of work if there are large numbers of in patients, or even certain standards that have to be met for the in patients that you have. Doing more with registration ought to lead to an improvement in animal welfare so it is surprising that the Royal College of Veterinary Surgeons has not grasped the opportunities involved.

The RCVS is one of the largest veterinary organisations in the United Kingdom. It spends hundreds of thousands of pounds on its IT infrastructure, has a substantial staff and premises and reserves amounting to millions. The College runs more than one register. On those registers for years it has distinguished between several categories of registered members and in its recent proposal to change its Charter suggested that it would create a new category of associate member. It also runs a voluntary practice standards scheme which practises have to register for. The College registers and de-registers people all the time and has evident expertise in the area.

For me then, the big surprise in the presentation is on slide 31 where it says "attempting to define a registered client would be unworkable". This is very surprising indeed given that this committee managed to define what a practising vet is...something that is quite difficult. However, if you go to the bottom of slide 31 you will see that the Committee also said, "...vets may charge higher fees to unregistered clients or offer registration as an alternative."

So the RCVS, an organisation that dwarfs most veterinary practices in the United Kingdom, and one which has evident expertise in the area of 'registration' does not feel that it can define a registered client; but practices can define a registered versus an unregistered client in order that they may set differential levels of fees (at their own risk). That's quite common, vets have been allowed to do that for years; I even know someone on Council that does it. As to what that differential could be, to the best of my knowledge you won't find any guidance anywhere on what's going to keep you out of trouble with the Disciplinary Committee in the event of a complaint.

I don't yet know what Council is going to do with all the recommendations, but if the Code isn't changing then not much has changed, despite the concerns. Such a shame that so many vets are going to have to continue to live in fear.