- The premises
- Employment of staff
- Veterinary surgeons
- Veterinary nurses
- Training of support staff
- Referral practices
- Continuity of care in veterinary practice
- Attendance away from the practice premises
- Case records
- Communication and consent
- Euthanasia of a healthy animal
- Euthanasia without the owner's consent
- Sporting events
- Destruction of injured horses
- Destruction of 'dangerous' dogs
- Referrals and second opinions
- Supersession
- Complaints
The premises
1. All practice premises must be clean and safe for staff, clients and patients, with waiting facilities and at least one dedicated consulting room. They must be adequately equipped for the services offered by the practice.
2. Details of the RCVS Practice Standards Scheme are set out in the annex RCVS Practice Standards. ‘RCVS Recognised Veterinary Hospitals' (RCVS Practice Standards Scheme, Tier 3) must conform to the standards laid down by the relevant practice standards.
Employment of staff
3. Veterinary surgeons who knowingly or carelessly permit anyone to practice illegally on their premises may be liable to a charge of disgraceful professional conduct.
Veterinary surgeons
4. Membership of the Royal College of Veterinary Surgeons is a legal requirement for anyone practising veterinary surgery in the United Kingdom. It is the duty of any veterinary surgeon employing professional staff to ensure that they are registered by inspecting the original RCVS certificate of membership or by checking with the RCVS.
Veterinary nurses
5. When employing Veterinary Nurses to undertake Schedule 3 procedures, it should be confirmed that their names are currently on the List of Veterinary Nurses maintained by the RCVS. As provided in Schedule 3 of the Veterinary Surgeons Act and the RCVS Guide to Professional Conduct for Veterinary Nurses, a 'veterinary nurse' means a person whose name is entered in the List of Veterinary Nurses, maintained by the RCVS.
Training of support staff
6. Veterinary surgeons should ensure that their support staff are competent, courteous and properly trained. In particular they must be instructed not to suggest a diagnosis or give any clinical opinion, to maintain confidentiality, and to discharge animals only on the instructions of the duty veterinary surgeon. They must pass on any request for urgent attention to the duty veterinary surgeon and be trained to recognise those occasions when it is necessary for a client to speak directly to a veterinary surgeon.
Referral practices
7. Referral practices must provide 24-hour availability in all their specialities, or they must, by prior arrangement, direct referring veterinary surgeons to an alternative source of appropriate assistance.
8. Appropriate post-operative or in-patient care must be provided by the referral veterinary surgeon, or by another veterinary surgeon with similar expertise (and at a practice with similar facilities); unless agreed otherwise with the client and provided that the welfare of the patient is not compromised.
Continuity of care in veterinary practice
9. Once an animal has been accepted as an in-patient for treatment by a veterinary surgeon or practice, responsibility for the animal remains with that veterinary surgeon or practice until another veterinary surgeon or practice accepts the responsibility.
10. Primary practices and out-of- hours emergency service providers must provide uninterrupted treatment of an in-patient, if it is considered that the animal is not fit to be moved.
11. Where an animal needs continuous in-patient care, a veterinary surgeon should not leave the animal until appropriate care is provided by a suitably qualified (eg MRCVS or Listed VN) colleague.
12. It is recognised that critically ill animals will sometimes need to be moved in order to receive appropriate treatment and primary practices should have appropriate transport and transfer arrangements in place. This may necessitate trained staff travelling with the animal.
13. When considering the transfer of critically ill animals, veterinary surgeons should consider the long term care that may be required and avoid, so far as possible, the need for such animals to travel more than necessary.
14. Where it is necessary and appropriate to transfer an animal between the primary practice and an out-of-hours emergency service provider or vice versa, the responsibility is that of the veterinary practices involved, not the client. Normally, the practice from which the animal is transferred is responsible for the transfer or arranging the transfer.
15. The transfer of a critically ill animal between practices should be in the animal's best interests, not for the convenience of the practices involved.
Attendance away from the practice premises
16. Clients often request attendance on a sick or injured animal away from the practice premises. It must be recognised that in some circumstances it may be desirable to do so. On rare occasions, it may actually be necessary on clinical or welfare grounds.
17. The decision as to whether attendance away from the practice is essential or not, is solely for the veterinary surgeon concerned, having carefully balanced the needs of the animal against the relevant health and safety issues for the practice personnel.
Case records
18. Case records should include details of examination, treatment administered, medication prescribed and/or supplied, radiographs, the results of any diagnostic or laboratory tests and advice given to the client. It is prudent to include notes of telephone conversations, fee estimates or quotations, consents given or withheld and contact details.
Communication and consent
19. Good communication skills in professional and support staff are essential to good veterinary practice.
20. Veterinary surgeons must endeavour to ensure that what both they and their clients are saying is heard and understood on both sides, and encourage clients to take a full part in any discussion. Explanations should be given wherever possible in non technical language and if there is any doubt as to whether the client has understood, this should be recorded.
21. Informed consent, which is an essential part of any contract, can only be given by a client who has had the opportunity to consider the options for treatment, and had the significance and risks explained to them. Cost may also be relevant to the client's decision. If it is anticipated that any procedure will be performed by a veterinary student, a listed veterinary nurse or other member of the support staff the client should be made aware of the fact.
22. If the client's consent is in any way limited or qualified or specifically withheld, veterinary surgeons must accept that their own preference for a certain course of action cannot override the client's specific wishes other than on exceptional welfare grounds.
23. When arrangements have been made to bring an animal under the Animals (Scientific Procedures) Act 1986 for experimental investigation, the client should be made aware of the general provisions of the Act so that informed consent can be given (see Annex 3B, A(SP)A and VSA interface and Annex 3E, Consent form specimens).
Euthanasia of a healthy animal
24. Euthanasia is not, in law, an act of veterinary surgery, and may be carried out by anyone provided that it is carried out humanely. No veterinary surgeon is obliged to kill a healthy animal unless required to do so under statutory powers as part of their conditions of employment. Veterinary surgeons do, however, have the privilege of being able to relieve an animal's suffering in this way in appropriate cases.
25. From time to time veterinary surgeons may face difficulties. For example, an owner may want to have a perfectly healthy or treatable animal destroyed, or an owner may wish to keep an animal alive in circumstances where euthanasia would be the kindest course of action. The veterinary surgeon's primary obligation is to relieve the suffering of an animal but account must be taken not only of the animal's condition but also the owner's wishes and circumstances. It should be recognised that clients are capable of making informed and conscientious decisions concerning the future of their animals. Thus the client is an important contributor to the decision. To refuse an owner's request for euthanasia, therefore, may add to the owner's distress and could be deleterious to the welfare of the animal.
26. Just as relevant are a veterinary surgeon's concerns about an owner's refusal to consent to euthanasia where an animal's immediate welfare is compromised. After full consideration of all the relevant issues, veterinary surgeons can only advise their clients and act in accordance with their professional judgement. Where, in all conscience, a veterinary surgeon cannot accede to a client's request for euthanasia he or she should recognise the extreme sensitivity of the situation and make sympathetic efforts to direct the client to alternative sources of advice. Where an animal's welfare is compromised because of an owner's refusal to allow euthanasia, a veterinary surgeon would be justified in informing the client of other action which might be taken.
Euthanasia without the owner's consent
27. The Animal Welfare Act 2006 (which applies in England and Wales), the Animal Health and Welfare (Scotland) Act 2006 and the Welfare of Animals (Northern Ireland) Act 1972 contain provisions to safeguard the welfare of animals. For animals in distress, there are no provisions in these Acts which specifically authorise a veterinary surgeon to destroy an animal. Under the 2006 Acts, powers to destroy an animal or arrange for its destruction are conferred on an inspector (who may be appointed by the local authority) or a constable. A veterinary surgeon may be asked to certify the condition of the animal is such that it should in its own interests be destroyed. An inspector or constable may act without a veterinary certificate if there is no reasonable alternative to destruction and the need for action is such that it is not reasonably practical to wait for a veterinary surgeon.
28. Under the Welfare of Animals (Northern Ireland) Act 1972, the police may summon a veterinary surgeon, or take action themselves, where the owner refuses to give consent or is absent.
29. The veterinary surgeon should obtain a written and signed instruction to destroy from the officer in charge, including his identity number and the log number of the incident at a given police station.
30. However, a person may commit an offence if an act or failure to act causes an animal to suffer unnecessarily. If, in the opinion of the veterinary surgeon, the animal’s condition is such that it should, in its own interests, be destroyed without delay, the veterinary surgeon may need to act without the owner’s consent and should make a full record of all the circumstances supporting the decision in case of subsequent challenge.
Sporting events
31. Where the veterinary surgeon is asked to destroy an animal injured in a sporting event, the opinion of a professional colleague, if available, should be sought before doing so. Veterinary surgeons officiating at sporting events should consider:
a. whether the owner will be present and able to consent to euthanasia if necessary
b. whether the owner has delegated authority to another to make that decision in their absence and
c. whether if damages were sought for alleged wrongful destruction they would have adequate professional indemnity insurance cover.
(Ref: the Horseracing Regulatory Authority [formerly the Jockey Club] Instruction J17 and FEI Article 1009.15)
Destruction of injured horses
32. The British Horseracing Authority's (BHA) Rules of Racing, which apply to BHA-regulated events, state:
‘Where, in the opinion of the attending veterinary surgeon, a horse is so severely injured that it ought to be humanely destroyed, the Owner or the Trainer should, wherever possible, first be informed. However, the veterinary surgeon may proceed with humane destruction, without reference to Owner or Trainer, in order to prevent undue suffering to the horse. Before taking this action the veterinary surgeon should, wherever practicable, seek a second opinion.’
(Ref: the British Horseracing Authority Instruction J17 and FEI Article 1009.17)
Destruction of 'dangerous' dogs
33. Under the Dogs Acts of 1871 and 1906, the Dog Control Act 1966, the Dangerous Dogs Acts of 1989 and 1991, the Dangerous Dogs (Amendment) Act 1997 and the Dangerous Dogs Order (Northern Ireland) 1991, a destruction order may be made by the Court ,or Justice of the Peace, or Sheriff, and the destruction of a healthy animal is normally involved. In these circumstances a veterinary surgeon asked to destroy a dog should, unless there is a genuine threat to human safety, request a written and signed order from one of the appropriate statutory authorities.
Referrals and second opinions
34. All veterinary surgeons should recognise when a case is outside their area of competence and be prepared to refer it to a colleague whom they are satisfied is competent to carry out the investigations or treatment involved. They should also be aware that the client has a right to request a referral or second opinion. Care must be taken not to give the impression to the client that the referral is to an 'RCVS recognised specialist' if this is not so. The initial contact should be made by the primary veterinary surgeon, and the client then asked to arrange the appointment (see Annex 3O, Referrals).
35. The distinction between a second opinion and a referral should be clearly understood by both veterinary surgeon and client. A second opinion is for confirmation of diagnosis, whereas a referral to a referral practice will be for diagnosis and possible treatment, after which the case will be referred back to the original practice. Neither a second opinion veterinary surgeon nor a referral practice should ever seek to take over the case.
36. The referring veterinary surgeon has a responsibility to ensure that the client is fully aware of the level of expertise of the referral veterinary surgeon, for example as a 'specialist' by experience, a certificate holder, or an 'RCVS recognised specialist'. The referral veterinary surgeon should discuss the case with the client and report back to the primary veterinary surgeon.
37. A full case history and instructions as to the particular reason for referral should be supplied, together with an indication of the client's wishes and responsibility for the fees incurred. Any further information which may be requested should be supplied promptly.
38. Veterinary surgeons should not use a referral as an opportunity to pass on difficult clients, or known bad debtors.
Supersession
39. Although both veterinary surgeon and client have freedom of choice, as a matter of professional courtesy and in the interests of the welfare of the animals involved a veterinary surgeon should not knowingly take over a colleague's case without informing the colleague in question and obtaining a clinical history.
40. When an animal is initially presented a veterinary surgeon must ask whether it is already receiving treatment, and if so, when it was last seen, and then contact the original veterinary surgeon for a case history. It should be made clear to the client that this is necessary in the interests of the patient. If the client refuses to provide this information the case should be declined.
41. In an emergency it is acceptable to make an initial assessment, and administer any essential treatment before contacting the original veterinary surgeon.
Complaints
42. Veterinary surgeons should be prepared to discuss their client's concerns directly with them, involving the practice principal if appropriate. If at this stage the difficulty cannot be resolved the aggrieved client may then be referred to the RCVS.
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