28 Apr 2021
Embracing the Vet-Led Team
In the second of our blogs looking at the RCVS Legislation Working Party recommendations, BVA Senior Vice President Daniella Dos Santos shares the thinking of the BVA working group tasked with looking at ‘Embracing the vet-led team’.
Our working group looking at embracing the vet-led team were tasked with considering the following RCVS LWP recommendations:
Recommendation 1.1: Statutory regulation of the vet-led team
Recommendation 1.2: Flexible delegation powers
Recommendation 1.3: Separating employment and delegation
Recommendation 1.4: Statutory protection for professional titles
To fully understand and appraise these recommendations, it is important to be clear on what Exemption Orders (EO) and Schedule 3 are. EOs are provisions in legislation that allow very specific and minor acts of veterinary surgery to be carried out by non-MRCVS, such as poultry vaccinations. Schedule 3 allows veterinary nurses to carry out medical treatment or any minor surgery that does not enter a body cavity. It must be under the direction of a veterinary surgeon who is satisfied the veterinary nurse is suitably qualified to carry out the task, and the vet must be the employer, or acting on behalf of the employer for the veterinary nurse. Schedule 3 also makes provisions for student veterinary nurses too. In the LWP report there is a recommendation (8.1) to allow for EO’s to be more easily amended to allow for greater flexibility and future proofing. This is a pragmatic approach supported by the working group provided the EOs remain narrow, specific, and clearly defined, and with assurances that any changes will be in consultation with the profession.
In 2019, BVA developed its own position on the vet-led team, with a hub and spoke model at its core. In this model the veterinary surgeon acts as the hub for treatment, directing to the most appropriate allied professional (the spokes), who refer back to the vet for further direction whenever necessary. This model allows for a co-ordinated approach, with the appropriate and efficient use of skills and better animal health and welfare and public health outcomes. The working group felt the model continuing to be appropriate for the vet-led team. However, for the vet-led team and its regulation to be truly successful in protecting animal health and welfare, there are various factors that need to be taken into account.
Regulation of the vet-led team
We support the principle of regulating allied professionals, however, for the regulation to be truly successful in protecting animal health and welfare, there are various factors that need to be taken into account. It is vital that any group brought under the RCVS regulatory umbrella is carrying out work that is science-led in order to prevent any undermining of the veterinary professions’ reputation, and they should also be able to demonstrate training, competence and continued education.
There are two routes by which a group of allied professionals could become regulated: the accreditation model or the associate model. The accreditation model is where the RCVS would accredit an organisation based on the regulatory structures the organisation already has in place and was originally favoured by the BVA vet-led team working group as it would be a more cost-effective way of regulating, and also minimise any potential reputational damage by association. The associate model, currently used to regulate veterinary nurses, is where RCVS provide registration services, set educational standards and develop a code of conduct. The associate model would come at a great cost to the RCVS, but reality is that any group that requires underpinning via changes to schedule 3, (ie where the activities carried out are not minor enough to qualify for an EO), would have to be regulated via the RCVS. As a result, the working group concluded that both regulatory models could be appropriate depending on the group of allied professionals in question. It is imperative that the cost of regulation of allied professionals does not incur a cost to the veterinary profession.
The group agrees no one should be denied the right to a livelihood and supports grandfathering rights in principle. However, these should be time limited, allowing individuals sufficient time to gain the appropriate qualifications to continue working.
Flexible delegation powers
Acts of veterinary surgery should, by default, be limited to veterinary surgeons. Having said that, delegation of tasks does rightly occur, allowing for the best use of skills within the vet-led team. In order to be future proof, the working group supports flexible delegation powers, provided appropriate checks and balances are in place, including consultation with the profession to any proposed changes to schedule 3 or its future equivalent.
Separating employment and delegation
There is an unjust anomaly when it comes to delegation and the employment status of veterinary nurses. Currently veterinary nurses are the only allied professional that must be employed by a veterinary surgeon, and others such as foot trimmers or physiotherapists do not. The group found there is no valid rationale for this anomaly to continue, and so supports the separation of delegation and employment: veterinary nurses are regulated professionals in their own right and should not be controlled by their employment status. However, there are some concerns around the potential unintended consequences of this and potential impact on the wider vet-led team concept.
It is vital that all work carried out by allied professionals, including veterinary nurses, continues to be genuinely vet led, whether it is work that falls under Schedule 3 or as part of a delegation of a treatment plan and continuity of care. It must be ensured that any delegation is not purely notional, especially when parts of care and treatment and associated tasks are essentially being carried out by different businesses. It is vital that “direction” is clearly defined, specific, and if appropriate takes the form of formal written instructions, with any deviation from them resulting in the case being returned to the veterinary surgeon for its next steps.
The decoupling or employment and delegation would undoubtedly open the way for a community nurse role, which is already taking place in the form of nurse home visits from several practices. The removal of the employment requirement would permit veterinary nurses to work “with but not for” a veterinary surgeon or practice. However, we don’t believe that community veterinary nursing is a specialism, nor does it require a separate title. As such, we have concerns over the movement to trademark the “District VN“ title and create a separate register, as not only is this unnecessary, but will further confuse the public, and hinder, rather than help, attempts to further explain and amplify the skills and role of veterinary nurses.
Protection of titles
The working group supports the protection of titles, and BVA have worked hard over the years, and will continue to do so alongside BVNA, to campaign for the protection of the veterinary nurse title. But the statutory protection of titles, beyond that of the veterinary nurse, is essential to underpin the proposed regulation of other paraprofessionals. Recognisable and protected titles are vital in providing clarity for vets, animals owners and members of the public, and is essential when it comes to communicating the benefits of the vet-led team to the wider public.
So what do you think? If you have any comments, please email [email protected]
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