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- Advancement of the Professions Committee
- Standards Committee
- Audit and Risk Committee
- Education Committee
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- Preliminary Investigation Committee
- Paper classification: some definitions
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- About extra-mural studies (EMS)
- EMS requirements
- Information for vet students
- Information for EMS providers
- Information for vet schools
- Temporary EMS requirements
- Practice by students - regulations
- Health and safety on EMS placements
- EMS contacts and further guidance
- Extra-mural studies fit for the future
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- Code of Professional Conduct for Veterinary Surgeons
- Code of Professional Conduct for Veterinary Nurses
- Contact the Advice Team
- XL Bully dog ban
- 'Under care' - guidance
- Advice on Schedule 3
- Controlled Drugs Guidance – A to Z
- Dealing with Difficult Situations webinar recordings
- FAQs – Common medicines pitfalls
- FAQs – Routine veterinary practice and clinical veterinary research
- FAQs – Advertising of practice names
- GDPR – RCVS information and Q&As
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- Accrediting veterinary degrees
- Accrediting veterinary nursing qualifications
- Reasonable adjustments for student vets
- Health and disability in veterinary medicine study and practice
- The role of the veterinary schools and the RCVS
- Reasonable adjustments and the Equality Act 2010
- Reasonable adjustments and Day One Competences
- Examples of reasonable adjustments for vet students
- Annex
- Reasonable adjustments for student vets - summary
- Reasonable adjustments for student veterinary nurses
- Health and disability in veterinary nurse education and training
- Reasonable adjustments for students and the UK disability discrimination legislation
- Educational assessment of veterinary nurses
- Roles of key stakeholders in the application of reasonable adjustments
- Examples of reasonable adjustments for vet nurse students
- Embracing reasonable adjustments for student vet nurses - summary
- External review of the RCVS by ENQA
- Requirements for remote and online student assessments
The prescribing cascade and new rules governing the distribution of veterinary medicines in Northern Ireland
In June 2025, a note was added to Chapter 4 of the supporting guidance to the Code of Professional Conduct to explain that the Veterinary Medicines Directorate (VMD) had announced that new rules governing the distribution of veterinary medicines in Northern Ireland (NI) will apply from 1 January 2026, and will change the way the cascade operates in NI.
The note included a link to this RCVS press release regarding the changes and the updated cascade steps in VMD guidance (applicable from 1 January 2026) - The cascade: prescribing unauthorised medicines guidance. It was also stated that the RCVS would update Chapter 4 of the supporting guidance accordingly.
The supporting guidance has now been updated and has been summarised below. We have also included information on the way the prescribing cascade will operate for veterinary surgeons prescribing in NI until 31 December 2025, and from 1 January 2026.
For ease of comparison, the relevant risk-based decision tree steps applicable for both periods, where possible, are set out side by side further down this page.
Chapter 4 of the supporting guidance
Chapter 4 of the supporting guidance has now been updated to:
- provide a concise overview of what the prescribing cascade is;
- include a link to the VMD’s Product Information Database to assist veterinary surgeons with keeping up to date with currently authorised veterinary medicines; and,
- to signpost veterinary surgeons to the latest VMD guidance on the cascade risk-based decision tree steps and broader cascade guidance/legal requirements relevant in the applicable territory.
The Standards Committee decided to streamline the chapter to make it easier to understand. Among other things, it aims to draw a clearer distinction between legal/regulatory requirements set by the VMD in accordance with the Veterinary Medicines Regulations 2013 (as amended) and the statutory remit of the RCVS under the Codes of Professional Conduct, Core Standard requirements, and expectations set out in the supporting guidance. The Standards Committee felt this provided additional clarity to the professions, especially in relation to where to go for further advice and guidance.
New rules governing the distribution of veterinary medicines in NI
The new rules include the introduction of two routes for sourcing veterinary medicines in NI:
This feature does not seek to provide guidance on these schemes, however, the VMD has published specific guidance for wholesalers/retailers and marketing authorisation holders in this respect.
Non-food producing species
| Steps applicable until 31 December 2025 - non-food producing species |
Steps applicable from 1 January 2026 - non-food producing species |
| Step 1: If there is no medicine authorised in NI or UK-wide for a condition affecting a non-food-producing species, the veterinary surgeon responsible for treating the animal(s) may, in particular to avoid unacceptable suffering, treat the animal(s) in accordance with the following sequence, in descending order: a veterinary medicine authorised in NI, or UK-wide for use in another animal species or for a different condition in the same species. | Step 1: Veterinary medicine with a Marketing Authorisation valid in NI (under an NI or UK-wide authorisation) or authorised in the EU for the same species, for a different indication, or for a different species for the same or another indication. For products not authorised in NI (under an NI or a UK-wide licence), a Special Import Certificate from the VMD is required. Separate arrangements apply for GB authorised products, see Step 4. |
| Step 2: If there is no such product(s) at step 1, either a human medicine authorised in NI, or UK-wide, or a veterinary medicine authorised for use in an EU Member State (a Special Import Certificate from the VMD will be required). | Step 2: If there is no authorised veterinary medicine as described in step 1, or those authorised are not available in Northern Ireland, then: A human medicine with a Marketing Authorisation valid in NI (under an NI or UK-wide authorisation) or the EU. For products not authorised in NI (either through an NI or UK-wide authorisation) a Special Import Certificate from the VMD is required. |
| Step 3: If there is no such product at step 2, a medicine prescribed by the veterinary surgeon responsible for treating the animal and prepared extemporaneously by a veterinary surgeon, a pharmacist or a person holding an appropriate manufacturer’s authorisation, located in the UK. | Step 3: If there is no authorised veterinary medicine as described in step 1 or 2 or those authorised are not available in Northern Ireland, then: Extemporaneous preparation prepared by a vet, pharmacist or person holding an appropriate Manufacturer’s Authorisation, in accordance with the terms of a veterinary prescription. |
| Step 4: If there is no such product at step 3, a veterinary medicine authorised outside of NI or UK-wide (a Special Import Certificate from the VMD will be required), or a human medicine from outside of NI may be imported in exceptional circumstances. | Step 4: If there is no authorised veterinary medicine as described in step 1, 2 or 3, or it is not available in Northern Ireland, then: A non-immunological veterinary medicine authorised for the same animal species and indication in GB or outside the EU may be used/imported. For products not authorised in NI (under an NI or a UK-wide authorisation), a Special Import Certificate from the VMD is required. Products that are authorised veterinary medicines in Great Britain may be imported under the Veterinary Medicines Internal Market Scheme without the need for an additional import certificate. |
The most notable change from 1 January 2026, is that veterinary medicines authorised in Great Britain (GB) - but not NI - may only be prescribed if there is no available (or suitable) authorised EU veterinary medicine, human medicine, or extemporaneous preparation. You will also note that where you choose to prescribe medicines authorised in GB (step 4 of the new steps), the Veterinary Medicines Internal Market Scheme permits you to do so without the need for an additional special import certificate.
Food producing species
Additional conditions will continue to apply alongside the cascade steps set out above in the left-hand column until 31 December 2025, as follows:
a. the treatment in any particular case is restricted to animals on a single holding;
b. any medicine imported from another country must be authorised for use in a food-producing species in that country;
c. the pharmacologically active substances contained in the medicine must have a Maximum Residue Limit (MRL), but not necessarily in the species for which it is intended to be used:
i. veterinary surgeons should consider the ‘other provisions’ listed with the MRL, for example, some substances are not allowed for use in animals producing eggs or milk for human consumption;
ii. allowed substances are listed in table 1 in the Annex to Regulation (EU) No. 37/2010;
d. the veterinary surgeon responsible for prescribing the medicine must specify an appropriate withdrawal period; and,
e. the veterinary surgeon responsible for prescribing the medicine must keep specified records.
From 1 January 2026, the VMD’s The cascade: prescribing unauthorised medicines guidance risk-based decision tree steps will apply to food producing animals. Most notably, the new guidance is more comprehensive and provides slightly different steps for food producing terrestrial animal species and food producing aquatic species. All food producing species are treated the same under the current guidance set out in this feature.
Queries?
If you have any further queries, please contact the following:
- For queries in relation to the steps applicable from 1 January 2026, please contact the VMD at [email protected] quoting ‘the cascade’ as part of the subject line.
- For further advice and guidance in relation to the Veterinary Medicines Health Situation Scheme and the Veterinary Medicines Internal Market Scheme, please contact the VMD by emailing [email protected].
- If you have any questions relating to the steps applicable until 31 December 2025 cited in our decision tree steps, or the updates to Chapter 4 of the supporting guidance, please contact the Standards and Advice Team on 020 7202 0789 or [email protected].
October 2025