15. Health Protocol

Updated 24 October 2017

Veterinary surgeons and registered veterinary nurses whose fitness to practise may be impaired because of adverse health

15.1  The RCVS Health Protocol aims to protect animals and the interests of the public by helping veterinary surgeons and registered veterinary nurses whose fitness to practise may be impaired because of adverse health.

 

Why does the RCVS need a Health Protocol?

15.2  The RCVS is the regulator of veterinary surgeons and registered veterinary nurses in the UK and has a duty to act in the public interest. This includes safeguarding the health and welfare of animals committed to veterinary care, protecting the interests of those dependent on animals and assuring public health through the regulation of ethical and clinical standards. The RCVS duty to protect the public interest also includes recognition of a veterinary surgeon’s or registered veterinary nurse’s own interests.

15.3  The RCVS recognises that sometimes it will be in the public interest to deal with veterinary surgeons and registered veterinary nurses suffering from adverse health without referring a case to the Disciplinary Committee or RVN Disciplinary Committee (DC) for a formal hearing. Generally, it is more appropriate to take a medical approach in cases involving medical problems.

15.4  In line with the procedures of other professional regulators, the RCVS Health Protocol is designed to allow the veterinary profession and RCVS to work together to protect the public interest by dealing appropriately with health-related cases. This Protocol provides that veterinary surgeons or registered veterinary nurses whose cases are not referred to the DC can be invited to give undertakings which may, for example, limit the extent to which they may practise. Cases may also be monitored by the RCVS through workplace and medical supervisors.

 

When can the RCVS take action in relation to a veterinary surgeon's or registered veterinary nurse’s health?

15.5  The Veterinary Surgeons Act 1966 (the Act) gives the RCVS powers regarding veterinary surgeons who are registered with the RCVS. Under the Veterinary Nursing Rules – Preliminary Investigation and Disciplinary and Restoration Proceedings (the Rules), registered veterinary nurses are subject to a similar regulatory jurisdiction. Under the Act and the Rules, the RCVS can only take action regarding a veterinary surgeon or registered veterinary nurse in the following circumstances:

  1. where a veterinary surgeon or registered veterinary nurse receives a criminal conviction which could render him or her unfit to practise; and,
  2. where a veterinary surgeon's or registered veterinary nurse’s conduct could amount to disgraceful conduct in a professional respect.

15.6  Where a veterinary surgeon’s or registered veterinary nurse’s adverse health is directly relevant to a criminal conviction, for example, an alcohol-related offence, or where adverse health is directly relevant to a veterinary surgeon’s or registered veterinary nurse’s professional conduct, this could render him or her unfit to practise, or amount to disgraceful conduct in a professional respect. The RCVS might take action where a veterinary surgeon or registered veterinary nurse is suffering from any health condition which compromises perception, cognition or insight in a manner which could impair fitness to practise.

15.7  When considering whether a veterinary surgeon's or registered veterinary nurse’s fitness to practise could be impaired because of adverse health, the following factors may be taken into account:

  1. The veterinary surgeon's or registered veterinary nurse’s current physical or mental condition
  2. Any continuing or episodic condition suffered by the veterinary surgeon or registered veterinary nurse,
  3. Any condition suffered by the veterinary surgeon or registered veterinary nurse which, although currently in remission, is capable of recurring.

15.8  A veterinary surgeon’s or registered veterinary nurse’s conduct could amount to disgraceful conduct in a professional respect in the following health-related circumstances:

  1. Refusal or failure by the veterinary surgeon or registered veterinary nurse to take or demonstrate reasonable steps to address adverse physical or mental health that could impair fitness to practise.
  2. Refusal or failure by the veterinary surgeon or registered veterinary nurse to take or demonstrate reasonable steps to address adverse physical or mental health where there is harm, or a risk of a harm, to animal health or welfare, public health or the public interest as a result.
  3. Refusal or failure by the veterinary surgeon or registered veterinary nurse to comply with reasonable requests by the RCVS, for example, to undergo a medical examination, provide medical reports or give undertakings.
  4. Breach of an undertaking given by the veterinary surgeon or registered veterinary nurse.

 

When should concerns about a veterinary surgeon's or registered veterinary nurse’s health be reported to the RCVS?

15.9  Anyone coming into contact with veterinary surgeons or registered veterinary nurses - including other veterinary surgeons, registered veterinary nurses, members of practice staff, clients, and healthcare professionals, for example, medical practitioners - who has concerns that a veterinary surgeon’s or registered veterinary nurse’s health may be impairing fitness to practise, is encouraged to report those concerns to the RCVS as soon as is reasonably practicable.

15.10  In addition, veterinary surgeons and registered veterinary nurses who are concerned about the health of another veterinary surgeon or registered veterinary nurse must also take steps to ensure that animals are not put at risk and that the interests of the public, including those of their colleague, are protected. This may mean reporting a colleague to the RCVS.

15.11  In many instances, the Veterinary Surgeons’ Health Support Programme (VSHSP) will be the first to come into contact with veterinary surgeons and registered veterinary nurses with health problems that may subsequently impair fitness to practise. Therefore, the RCVS and the VSHSP and Vet Helpline have agreed a Memorandum of Understanding clarifying the respective roles of the organisations.

15.12  The RCVS has a duty to act in the public interest, including recognition of a veterinary surgeon’s or registered veterinary nurse’s own interests, and will investigate sympathetically and sensitively any health-related concerns brought to its attention.

 

How does the RCVS deal with concerns about a veterinary surgeon’s or registered veterinary nurse’s health?

15.13  Health concerns may be brought to the attention of the RCVS, or be relevant to a complaint or a conviction case. All investigations follow a similar procedure and timeline as complaint cases not involving adverse health.

15.14  The RCVS Preliminary Investigation Committee and RVN Preliminary Investigation Committee (PIC) conduct a preliminary investigation under the Act or Rules. The PIC decides:

  1. whether there is a realistic prospect of finding disgraceful conduct in a professional respect or a conviction which renders a veterinary surgeon or registered veterinary nurse unfit to practise; and, if so,
  2. whether it is in the public interest to refer the case to the DC for a full hearing.

When undertaking both elements of this assessment, the PIC may take into account the health of the veterinary surgeon or registered veterinary nurse if relevant. PIC meetings are held in private and information will be discussed confidentially.

15.15  When considering whether a veterinary surgeon's or registered veterinary nurse’s fitness to practise could be impaired because of adverse health, the PIC will refer the case to a Medical Examiner for consideration who, together with the other Case Examiners, will recommend medical examinations and/or undertakings relating to the veterinary surgeon or registered veterinary nurse to be agreed with the PIC.

15.16  If the case is sufficiently serious, referral to the DC will be necessary in the public interest, despite any issues surrounding the veterinary surgeon's or registered veterinary nurse’s health.

15.17  However, once the PIC has investigated a case, it may decide in light of all relevant circumstances, including the veterinary surgeon's or registered veterinary nurse’s health, that it is in the public interest not to refer the case to the DC, at least at that time. The PIC may then:

  1. hold the case open for a specified period of time; or,
  2. adjourn consideration of the case for a specified period of time.

15.18  Where the PIC has decided to hold a case open or adjourn consideration for a period of time, it may also take reasonable steps in the circumstances to protect the public interest, for example, it may:

  1. invite the veterinary surgeon or registered veterinary nurse to undergo medical examinations, assessments, or tests which may be at his/her expense;
  2. invite the veterinary surgeon or registered veterinary nurse to agree to be visited and interviewed by RCVS representatives, for example, a Senior Case Manager and/or a veterinary investigator;
  3. invite the veterinary surgeon or registered veterinary nurse to provide medical reports to the PIC which may be at his/her expense;
  4. invite the veterinary surgeon or registered veterinary nurse to embark on a course of treatment recommended by a medical practitioner at his/her expense; and,
  5. invite the veterinary surgeon or registered veterinary nurse to give undertakings to the PIC. 

15.19  If the PIC decides to invite the veterinary surgeon or registered veterinary nurse to give undertakings, it must ensure that any such undertakings are proportionate, targeted, workable and measurable. The PIC may draft and refer to a list of possible undertakings which will be made available to the public and regularly reviewed. The types of possible undertakings are not limited to those set out in the list of undertakings but may include, for example:

  1. undergoing treatment from the veterinary surgeon's or registered veterinary nurse’s treating clinician at his/her expense;
  2. supervision by a medical supervisor appointed by the RCVS. The medical supervisor will not be the veterinary surgeon's or registered veterinary nurse’s own treating clinician;
  3. supervision by a workplace supervisor appointed by the RCVS, who may be a suitable colleague in the same practice;
  4. specific undertakings to address concerns identified by the RCVS or the medical supervisor, for example, relating to the veterinary surgeon’s or registered veterinary nurse’s practice or the specific facts of the case;
  5. undertakings allowing the sharing of information between relevant persons, for example the veterinary surgeon's or registered veterinary nurse’s treating clinician, employer, medical supervisor, workplace supervisor and the RCVS; and,
  6. submitting to blood, urine or other medical tests.

15.20  An undertaking is a formal promise given in writing and signed by the veterinary surgeon or registered veterinary nurse. A veterinary surgeon or registered veterinary nurse giving undertakings will be notified that breach of an undertaking could result in referral of the breach to the DC and that the original case considered by the PIC may also be referred to the DC.

15.21  The undertakings relating to a specific veterinary surgeon or registered veterinary nurse are not made public by the PIC, unless there is an overriding public interest in disclosure. Similarly, once undertakings have been given by a veterinary surgeon or registered veterinary nurse, managing compliance with those undertakings takes place in private, unless there are overriding public interest reasons for disclosure.

15.22  When monitoring a held-open or adjourned case, the RCVS adopts a proactive approach to ensure compliance with undertakings. This involves regular liaison between the RCVS, usually a Senior Case Manager, and any relevant individuals, such as a medical supervisor and workplace supervisor. The PIC may also direct, where appropriate, that any reports, test results or similar documents should be submitted and considered by a case examiner, case manager, the PIC Chairman or at a full meeting of the PIC.

15.23  The PIC may invite a medical supervisor, workplace supervisor or other relevant individual to attend a PIC meeting and report in relation to the veterinary surgeon or registered veterinary nurse. The veterinary surgeon or registered veterinary nurse will be informed when any person has been asked to attend a PIC meeting and be invited to comment on the attendance by that individual. A written note of the individual's report to the PIC will be made available to the veterinary surgeon or registered veterinary nurse after the PIC meeting.

15.24  A held-open or adjourned case may be further held open or adjourned by the PIC for as long as it is considered to be necessary in the public interest. Monitoring will be carried out until such time as the PIC considers that the case may be closed or that it should be referred to the DC. In any event, the PIC will formally review individual cases at least once every 12 months.

 

What happens if a veterinary surgeon or registered veterinary nurse does not cooperate with the PIC when it investigates a health case, or where undertakings are breached, or where further matters arise?

15.25  A failure to cooperate with the PIC, or a breach of undertakings, could each amount to disgraceful conduct in a professional respect. The PIC may refer such cases to the DC on their own, with or without the original case that was considered by the PIC.

15.26  If additional matters, for example, concerns resulting from information provided in compliance with undertakings, or further conviction or conduct complaint cases come to the attention of the PIC during the course of its management of a held-open or adjourned case, the PIC may decide to refer all or any cases to the DC, following any additional investigation that is considered necessary.

 

What if the public interest requires a veterinary surgeon’s or registered veterinary nurse’s name to be removed from the register?

15.27  The PIC may always refer cases involving health-related concerns to the DC if it considers it to be appropriate and just, having regard to its duties under the Act or the Rules.