Introduction
Abi Judd-English (00:24)
Hi everyone and welcome to the October edition of the RCVS podcast where we update you on all the goings on at the College, explaining why we do what we do, how we do it and how we can all work together as we continue to support the advancement of the veterinary professions.
My name is Abi Judd-English, a member of the RCVS Communications Team and today we're joined by my Communications Team colleague, Luke Bishop, as well as our in-house research manager, Vicki Bolton and our new Chair of Veterinary Nurses Council, Kirsty Young, who will be chatting to us about our recently published research on the possibility of a future veterinary nurse prescriber role.
The conversation will explore how the research came about, what it showed and next steps moving forward. We'll then be joined by our Director for the Advancement of the Professions, Angharad Belcher, who will be speaking with our CEO, Lizzie Lockett and Dr Jen Brandt, the Director of Member Wellbeing Initiatives at the American Veterinary Medical Association, also known as the AVMA, about MMI International, an initiative co-founded by the RCVS and the AVMA back in 2018 to bring together leading veterinary organisations from around the world to tackle mental health challenges within the veterinary professions.
They will also be discussing the most recent development in the initiative, a series of international Vital Transitions events, which launched back in September.
But first, we have our usual news roundup.
News round up
Abi Judd-English (01:54)
At the end of September, we launched a new survey for the professions in order to better understand how our under care guidance is working in clinical practice, three years after its initial launch. The guidance included information on prescribing prescription-only veterinary medicines, as well as guidance on limited service providers and information and advice-only services.
The survey will now seek to gather feedback and insights from the professions about how the guidance is working on a day-to-day basis and its impact on prescribing behaviours.
The deadline to respond to the survey is 5pm on Monday 26th October 2026 and the link has been added to the show notes.
We're currently seeking additional examiners to support the delivery of the certificate and advanced veterinary practice synoptic examination and are inviting expressions of interest from suitably qualified veterinary professionals, such as advanced practitioners and specialists. The role involves working alongside another examiner to produce three unseen cases and assess candidates undertaking the synoptic examination, helping to ensure a fair, consistent, and high quality assessment experience.
More information on the role and how to apply can be found in the show notes.
On Monday the 2nd of November, we're inviting members of the veterinary community to join us for an RCVS Mind Matters Research webinar, exploring the development of ‘Euthasafe’, a portable app controlled solution for safe drug handling.
The webinar, which is being run as part of the College's ongoing work on suicide prevention in veterinary workplaces, will explore the innovative technology designed to address suicide risk relating to access to lethal drugs and the evidence behind it.
It will cover how risk could be mitigated or minimised, feature insights into applying for research funding and offer opportunity for discussion and reflection. You can find a booking link in the show notes.
Finally, this autumn our Academy Live sessions are back. We're inviting veterinary professionals to join us for our popular free online live CPD sessions covering a wide range of topics based around some of our RCVS Academy courses.
Upcoming topics include ‘clinical supervisor: tackling tutorials’, ‘CPD: record and reflect’, and ‘RVN starting out: building confidence’. To find out more and book your place, see the link in the show notes.
VN prescriber research feature
Luke Bishop (04:14)
Hi there, this is Luke Bishop, Media and Publications Manager at the RCVS. We are going to be having a discussion about the recently published VN prescriber research, which was published this summer, which was looking at the feasibility of a future veterinary nurse prescriber role.
To find out more about this research, its aims, how it was conducted and its conclusions, we're joined by Kirsty Young, who's the new Chair of VN Council, and by Vicki Bolton, who is the RCVS Research Manager.
Vicki Bolton (04:40)
Hi, Luke.
Luke Bishop (04:41)
Good afternoon to you both. So to start off Vicki, I was just wondering if you could tell me a bit about how the research came about.
Vicki Bolton (04:49)
Well, it actually goes back quite a long way. It goes back to the 2017 Legislation Working Party. They were interested in these questions and they talked to stakeholders, groups like the BVA and the BVNA, and they asked, what would your group think of a vet nurse prescriber role and the responses were overwhelmingly positive but there was an exception in one area. There was some concern from some of the stakeholder groups about first vaccinations. So, most of the groups said that there's no risk to animal welfare associated with allowing vet nurses with appropriate training to prescribe and then give a first vaccination to a young pet. But there were a few who thought there could be a risk because then the little animal wouldn't have its health checked by a vet but rather by a vet nurse at the first visit.
So, the Legislation Working Party asked if we could do a bit of research and Professor Stephen May helped the Working Party to design a project and the aim was to answer questions about the risks of having a vet nurse perform a health check rather than a vet and to draw out ideas about what kinds of training would be appropriate if a vet nurse were doing those checks.
So it's a bit of a lengthy history, but it started back before Covid, back in 2017-18.
Luke Bishop (06:11)
And talking about this particular research project, could you tell me a bit about the process involved in kind of commissioning and conducting this?
Vicki Bolton (06:18)
Yeah, it’s pretty cool and I can say that because Stephen May designed it and not me, but it is pretty cool. So, first of all, the Working Party commissioned researchers at University of Liverpool where they hold the SAVSNET data, that's Small Animal Veterinary Surveillance Network data. And those records are records of real consultations that have been recorded by a veterinary professional at the time and each consultation is tagged with its main purpose.
So the researchers at Liverpool chose all of the consultations where the main purpose was a vaccine and they drew a stratified random sample of consultations for the main vaccinated species, so dogs, cats and rabbits, and they did it in two categories, so the juvenile ones, the little ones coming for their first vaccination, and senior or older adult dogs, cats and rabbits.
And then, the free-text record of each consultation was read by two researchers. So, the vet, when they conduct the consultation, tick a box that says this is the main purpose, in this case a vaccine consultation, and then they write down what happened in the vaccine consultation and it's their free text that the researchers read. And roughly 70 % of consults had something else in there. So it wasn't just the vaccine, 70 % had something else recorded as well.
And this is what makes it so cool - that these are real consultations. So, this is not what might happen in a vaccine consultation. This is what actually happens in vaccine consultations. And in those consults, there were 539 conditions which were not the vaccine being delivered. And these were cut down to 43 by grouping very similar conditions together. Conditions that were only recorded once out of the 4,000 odd consoles were removed. So, conditions that turned up twice were included, but not the ones that only turned up once.
Conditions that were likely to be identified by the owner rather than the vet professional were excluded as well and I'm probably going to end up talking about that more because it's had some quite interesting effects on the research.
Anyway, it was boiled down from 539 to 43, and those 43 conditions were presented to two expert panels. And when I say expert panels, I mean expert at being a veterinary professional, either a vet surgeon or a vet nurse. So not expert at policy or expert at talking to RCVS, but expert at doing their job. So mid-career veterinary professionals working in practices where it's normal to have vet nurses around. So, these were vet nurse training practices. So, these should be vets and vet nurses who have a lot of experience of doing this kind of work.
And we used a Delphi methodology, which is another thing that's kind of cool. This is the first time I've done a Delphi methodology. I really enjoyed it. The idea is to reach a consensus. So what you've got is a panel. In this case, we had such a fantastic response from the registered professionals that we had two panels because we had so many people who were willing to help us out. And the aim is to help the panels reach a consensus. So we showed them the 43 conditions and asked them to tell us whether a nurse would be able to correctly refer the conditions and then to rate the risk to the animal, the risk to animal health and welfare if the condition was not referred.
So we showed them the 43 conditions in round one and then if they all agreed, if every panel member agreed, we said 80 % was a consensus. So if 80 % agree that the nurse with five years experience of conducting health checks in small animal clinics, if they all agree that that imaginary nurse could correctly refer the condition, we just accepted that as a consensus. And then that condition doesn't go forward to round two, then round two, the conditions where they didn't agree come back again.
We asked them some additional questions about what kind of training they thought might help at round two. So the idea was to come up with a full list of conditions that really come up in vaccine consultations that professionals can reach a consensus would be recognised, would be correctly referred, and then there's also a much shorter list of conditions where they couldn't agree.
Luke Bishop (10:47)
One for you Kirsty, like Vicky said, the level of consensus was the majority of the identified conditions were agreed upon, but why were certain conditions harder to find consensus on in the research?
Kirsty Young (10:59)
So there's a number of different reasons for that. Some of the panels found some of them hard to agree on because, for example, the research was set up to exclude history taking and that might be quite significant in the identification of that condition. So for example, back pain was one of them and probably it would be difficult for anybody really to identify back pain without some history taking.
Also there was difficulty where there was a condition requiring a diagnosis.
So for example, something like a patella luxation is a diagnosis, but the veterinary nurse would be perfectly capable of identifying something like pain or lameness. So they weren't needing to make the diagnosis, but they could still identify that there was an issue there. And then some conditions were difficult to agree on because the panel members had maybe difficult experience or knowledge of veterinary nurses or the hypothetical veterinary nurse. And so therefore, it might be that people interpreted that one vet nurse might be able feel or hear the abnormal lung sound and so you know they might find that others might have more difficulty with that so it would depend on their experience of the nurses that they've come across as well.
Luke Bishop (12:06)
Going back to the first principles, I guess, human nurses are able to prescribe under certain circumstances. Why don't veterinary nurses currently have those same powers?
Kirsty Young (12:17)
So human nurses and other prescribers have different opportunities to be able to prescribe. Some of that requires additional training and that's been identified and so forth. You might well see nurse practitioners and they've got a very specific status and training that we don't have currently within veterinary nursing. We also are restricted within the veterinary medicine regulations currently. However, those are due to be reformed so we want to discuss what we'd like to see in the future within those regulations and have the opportunity to hopefully put into that review and try and get that freedom within the veterinary medicines regulations.
Luke Bishop (12:53)
And how do you think, looking at the research and I guess kind of using your own kind of professional knowledge, how do you think vet nurse and vet opinions might differ on this and also why might there be essentially some differences of opinions between different practices as well?
Kirsty Young (13:10)
As Vicky said earlier, there is lots of support both from the veterinary nurses and with vets to be able to allow veterinary nurses to prescribe. I certainly think that it will help veterinary nurses to be empowered, ensure that they've got, you know, being able to work within a full remit. It's positive for patient care, potentially can assist costs to clients and certainly hopefully have more opportunity, more flexibility for that patient care, so positive for animal welfare as well. But I think both vets and vet nurses can have a variation in different confidence levels, so maybe vets, there's a lot that work with nurses that are very confident within their area and have absolute confidence in them to able to prescribe. Others have maybe got less of experience of that and not so much experience as to what training vet nurses get.
And also, vet nurses, if they're not able to be able to fulfil their full remit, often they are a bit less confident and can't necessarily see themselves initially carrying out that role. But I think with further training and us identifying what support they would need to be able to fulfil that, then there's lots of opportunities there.
Luke Bishop (14:21)
And again, like you say, this is a bit of a hypothetical, but what kind of training would you expect a nurse to have to undergo to carry out this potential future role?
Kirsty Young (14:30)
And so certainly there's already training within the syllabus about medical conditions, etc. during patient examinations, but potentially taking that a step further, making sure that's really clear within the day one competencies and skills to make sure that there is a clear understanding about the types of, you know, auscultation, etc. that is required to be able to robustly examine a patient and pick up any potential issues that they would need to refer on.
And additionally making sure that nurses are able to make clinical decisions, understand that role and we can decide whether that's at a day-one-competent level or that it takes an advanced status to be able to do some of this prescribing and therefore make sure that we've got additional training that is suitable for that prescribing, just like medical professionals and nurses in the human world.
Luke Bishop (15:16)
Thank you very much. Back to you for this one Vicki. If you designed the research again, what different questions would you ask?
Vicki Bolton (15:24)
Well, as I've said, my favourite thing about the research is that it's based on real consultations. And that's a huge strength because it means it's not theoretical. We're not talking about what might come up. We're talking about what did come up.
But it could also be a weakness in that, I'm thinking about the conditions where the panels didn't reach a consensus. So those conditions were much more likely to have come from a consult with an older animal.
And when you think about it, in a consultation happening for real in a practice, the older animal may well be known to the veterinary professional doing the vaccination anyway, and all of their notes will hopefully be available. So any diagnoses that they already have will be written in their notes for the veterinary professional who's conducting the consult. So I think some of these conditions that came up especially with older animals are not necessarily the kind of things that would come up in the hypothetical scenario that we gave. So a vet nurse with five years experience doing a health check for a new client with no history and no owner report. So I think that's something that I would think about again and in that vein, I think I would add history taking into the scenario. So history taking is such a key clinical skill and so many of the conditions where the panels couldn't reach a consensus would have been identified based at least in part on a report from the owner as Kirsty said a minute ago. And so I think it might have been easier for our expert panels to come to an agreement if we'd allowed them to imagine that there could have been some history taking.
Luke Bishop (17:15)
And a question for both of you, guess, what comes next? What's going to be done with this research and what kind of discussions are going to happen from here?
Kirsty Young (17:25)
Well certainly we've been discussing this within Veterinary Nursing Council, real sort of robust positive discussion about the opportunities here and the team at RCVS are looking at sort of benchmarking against the human field, looking at what the pros and cons are for different options and so we want to discuss those options and investigate those options in more detail and potentially come up with a future model.
Luke Bishop (17:49)
Fantastic. Any further research, planned Vicki or further analysis?
Vicki Bolton (17:53)
There's nothing immediately on the stocks, but I think what Kirsty said about looking at the model is absolutely right. This research, as I said, it really kicked off in 2017 and the world's moved on since then. And I think it's really important to consider an appropriate model before we do any additional research or consultation.
Luke Bishop (18:13)
Well thank you both very much for your time and yes I hope the fruitful discussions will continue from here. Thanks very much.
Vicki Bolton (18:22)
Thanks, Luke
Mind Matters International sub-feature
Angharad Belcher (18:43)
And now we have a short feature looking at Mind Matters International. We have two influential leaders joining us today, both of whom have championed mental health and wellbeing from both sides of the ocean. I'm delighted to welcome Dr. Jen Brandt and Lizzie Lockett. So Jen, can I come to you first and could you introduce both yourself and AVMA, please?
Dr Jen Brandt (19:00)
My pleasure. My name is Dr. Jen Brandt and I am the Director of Member Wellbeing Initiatives at the American Veterinary Medical Association. And the AVMA is a 111,000, I think, member strong organisation that advocates and serves as a voice for veterinary professionals in the US.
Angharad Belcher (19:20)
That’s a large number of people to be looking after and representing. So thank you very much for joining us. And Lizzie, can I come to you? Can you tell us a little bit more about yourself, please?
Lizzie Lockett (19:28)
Absolutely. So I'm Lizzie Lockett. I'm the chief executive of the Royal College of Veterinary Surgeons. I've actually been at the College for 21 years, although not always in this role. I've been Chief Executive since 2017. And prior to that, my role was looking after communications activities for the College and also setting up the Mind Matters initiative here in the UK back in 2014, I think it was.
Angharad Belcher (19:50)
Which is feeling like a very long time ago, that's for sure.
So thank you very much for joining us. For those of you who are listening to this now and thinking, hang on a minute, the RCVS is a UK-facing organisation. So where does the international element come into this? Could you just explain how we interact at a global level and then what that means for mental health, please?
Lizzie Lockett (20:10)
Yeah, absolutely. So although our statutory remit is just for the UK, as a Royal College and a regulator, it's really important that we're part of an international community. There's only one veterinary regulator in the UK, so we need to learn from, collaborate with our peers and regulators and leadership bodies like AVMA in other countries. And coupled with that, the veterinary professional course is international one. It's a mobile global community of professionals with huge opportunities to work in other countries. And of course, disease knows no borders.
And neither does the likes of AI regulation, of which we're grappling with at the moment. So there's lots of challenges for us. So working with similar organisations in other countries, it brings real benefits to our members and registrants, to animal health and welfare and public health, and also to us as people operating this space, to be able to share, build networks, horizon scan for challenges, and work together on how we might tackle those.
And so we do that through being members - I mean, in addition to kind of informal networks - we're members of organisations such as the Federation of Veterinarians of Europe and the International Veterinary Regulators Network. And then we also have some very specific collaborations on particular areas. And one of those is the Mind Matters International Project.
So as I said at the start, we set up Mind Matters quite some time ago now. We celebrated our 10th anniversary quite recently. And the aim of that project, if you're not familiar with it, is to support members of the veterinary team with the tools and knowledge that they need to manage their mental health. And that kind of management piece is flanked with upstream work to try and address the impact of mental health issues, for example, by changing our guidance, funding research, addressing systemic problems. And then also at the other end of it, by financially supporting independent services that can help people who really are in distress. So that's the UK work and that directly affects and engages members of the veterinary team.
But some time ago, we recognised that there was scope to help other organisations in the same space to grapple with the same issues really. So, Mind Matters International is not so much about working with international vets and nurses on the ground, it's about working with the associations and regulators that are helping to support them.
So, we teamed up with AVMA and with Jen and colleagues at the time to develop this organisation that really works at a slightly different level to Mind Matters here in the UK.
And we basically encourage organisations to sign up to join Mind Matters International. We've got about 12 organisations signed up at the moment with a mix of in-country organisations and pan national organisations and some global organisations. And in order to join us in this challenge, they have to sign up to a statement to say that they really recognise the importance of positive mental health within their veterinary profession. And they have to talk about the way in which they're actually genuinely committed to that. So it's not just a kind of whatever the mental health equivalence of greenwashing is, they actually have to say what they're doing to prevent, protect and support mental health in their areas. So it's quite a good commitment. And then how we actually operate is mainly through online meetings where we share projects, we share best practice, we pool our voices and we pool our funding, if that's possible to do as well.
So we've run quite a lot of sessions over the last few years, looking at case studies around research, for example, or tackling particular challenges. I remember some really useful sessions we had during COVID when we just shared some of the difficulties that we were all going through. And there were so many common areas that we could then just work together on. So just on that front, if you happen to be listening to this and work for an association or a regulator and want to find out more about joining us organisationally, then do please get in touch. So hopefully, Angharad that gives you a of a whistle-stop tour in terms of what we're up to.
Angharad Belcher (23:43)
It does indeed. Thank you so much for explaining that and helping people to see how we interact and equally how they can benefit from those interactions. So Jen, coming to you, and I'm conscious that there is a there's a big time difference here, which can be one of the many challenges i getting people together and communicating, but for you and AVMA, why is it important to engage at this global level around things like mental health, given that there's such a difference in expectation and understanding and cultural challenges around the world as to how we all interact with mental health?
Dr Jen Brandt (24:14)
Absolutely. as you say, yes, there are differences. There are also a stunning number, or surprising number, of commonalities that we share. And I think that's one of the things that's so rewarding about the calls and the connections that we have. One, you're gathered together with people who are so passionate about veterinary medicine and so dedicated to the health and wellbeing of the profession.
And then when we get together and talk about some of the commonalities that we share, like transitions into the workforce and those types of things, it's an opportunity to learn what other people are doing that is specific to their cultural context, but that there might be elements that we can learn from that. And we also can discuss what parts of that worked, what didn't work. If you were to do an initiative like that again, what might you do differently?
And so we all are having a chance to share what's working or not working for us, what we might move forward, what we could work together on collectively and accomplish even more, or how we can take what we're learning and customise it to our culture or context. And so it's an incredibly important shared resource and having that connection so that we learn from each other and we can do even more on behalf of the profession.
Angharad Belcher (25:31)
The connection piece there I think is really vital in how we can figure out those relationships going forward because I know that when we've had those types of meetings it's been really gratifying to see that other people are also facing those same how do we do this? How can we make things better? How can we collectively move forward on this even when it seems as though something might be an impossible task. So yes I think you've raised some really good points there.
So the reason that we're here today is to talk about one of the upcoming events that we're doing at an international level. It's the first time we've done something quite like this. So, Lizzie, could you tell us a little bit more about the Vital Transitions event, please?
Lizzie Lockett (26:08)
I can absolutely. So I would think about it perhaps less like an event as a series of events. So what I think we all got really used to doing during the pandemic was having meetings online, including symposium and all sorts of different conversations. And there's been brilliant things about that move. Certainly it helps bringing global communities together. It's been good for the environment in terms of reducing travel.
And also I think it makes meetings more accessible. But there have been downsides. I think there has been some downsides to not being able to meet in person, have that really rich kind of interaction and all those unexpected conversations that you have while you're in the queue for the coffee or whatever it happens to be. So we thought, why don't we try and bring together what's been really good about online and what really works? We know works about in-person activities and kind of have a deconstructed event. So rather than having one big online event or one big in-person event, split this up into chunks which bring together the best of both worlds. The theme is around vital transitions as Angharad says, and it's about that transition from education, veterinary education, whether that's further education or higher education, apprenticeships, to the workplace and the stresses and strains that come along with that.
So as an individual, you're used to perhaps being really well supported in veterinary school. You come into a practice that may have great intentions, but is super busy, there's lots of things going on and that wraparound support is no longer there. Also, things start to go wrong perhaps in a way that people haven't anticipated. You're away from home, you're away from your social networks and in the cases of some countries that are part of our groups, large parts of the veterinary workforce in Canada, for example, that come from outside of Canada. So you're not only away from home, you're away from your home country. So all of these things come together to potentially cause some difficulties. And we do also know that those first formative months and years are so important, not only at the time, but also shaping your relationship with work and the workplace for many, many years to come. I can still think about the positives and the negatives of my first job and how that's impacted the way that I work and lead now.
So that's the theme and we think it's one that is relevant to all of the countries that we're engaging with and we did some pre-work to check that, to sort of sanity check that theme. In terms of how it's going to happen, we start with some pre-reading. So that will go out to everybody who's due to be at the first meeting. Then on the 30th of September, we had an online meeting focusing on research around this topic. So research that's being carried out specifically into transition so that we can really get a good evidence base for the conversations that follow. And that's always been a hallmark of the way that Mind Matters was set up and particularly the work that Angharad and Sam and Rapinder have been taking forward that evidence base is really, really important.
Following that meeting, there'll be then discussion taking place at a more regional level. So for example, we've got an in-person meeting happening in Brussels. There will be other meetings, some online and some in person in other countries, so North America, Australia, etc. Quite how that works is more down to those individual countries to run it. But that will be conversations around the specific issues raised, what resonated from the research and what action can be taken to better support people going through that transitional period into the workplace.
We then come back together again in an online plenary to share planned activities and to see if there's any areas for collaboration and mutual support.
And then at some time after that, depending on the work streams that are identified, there will be a meeting to review progress against those agreed actions. And I'm really hoping that we get some interesting pieces of work where we can collaborate together, pool resources. There's never enough money and time to do these things properly, so hopefully we all piece together what we've got. We'll be able to come up with some work that will have a real impact on members of the veterinary team as they take those first formative steps into their professional careers.
Angharad Belcher (29:52)
I think it's going to be really interesting to see this research come to life and see how people interact with it. So thank you for explaining that side of things. So going forward, we will then see what the outcomes are and hopefully some outputs that will also be quite tangible and an opportunity for people to learn a bit more. We know that this will be a few months in the making because of needing to organise the different events in different parts of the world. So it might take a little while for listeners here today to see that but it will be on the website and we will share it with people more broadly.
So thank you both very much for introducing the concept of how this works at an international level. For those of you who might be inspired as part of your organisations to get involved, then please do. These opportunities can be really exciting and a really fulfilling experience to be part of something a bit bigger. And we really appreciate your time today. So thank you, Jen and Lizzie for joining us and hopefully we will see you very soon.
Lizzie Lockett (30:48)
Thank you.
Outro
Abi Judd-English (31:02)
Many thanks to Luke, Vicki and Kirsty, and Angharad, Lizzie and Jen for some really insightful discussions today.
More information on both the VN prescriber research and the work of MMI International can be found in the show notes. Don't forget that listening to this episode counts towards your CPD, so be sure to record and reflect on the 1CPD app.
If you have any ideas for future podcast content, please don't hesitate to reach out to us on [email protected].
Many thanks for listening and we'll see you next time.
