Roker Park Vets Owner and Veterinary Surgeon, Rory Thomson BVMS MRCVS, shares his views on the ‘red tape’ that is increasing prices for clients

One of the points the Competition and Marketing Authority (CMA) are investigating within the veterinary industry is if the regulatory framework is preventing the market from functioning as well as it could.

It was in 1844 that the Royal College of Veterinary Surgeons (RCVS) was born, recognising the ‘veterinary art’ as a profession.  A Royal Charter was created to empower the RCVS to advance standards as well as set and uphold them, in the interests of the health and welfare of animals. In 1881 the first Veterinary Surgeons Act distinguished between qualified veterinary surgeons and unqualified practitioners, who were still able to provide veterinary services despite not having any formal training, much to the frustration of James Herriot in his earlier books.

In 1948, the Veterinary Surgeons Act was updated, making it unlawful for anyone other than a veterinary surgeon to practice veterinary surgery.  In 1966 the current Veterinary Surgeons Act became law, which expanded on the 1948 Act providing more regulatory power for the RCVS to self-regulate its veterinary surgeon members.  The Veterinary Surgeons Act provides the legislation underpinning how the RCVS is governed and by whom, allowing it to regulate its members without government intervention.  The RCVS regulates the profession by keeping registers, setting codes of professional conduct, setting educational standards and having complaints and disciplinary procedures enabling removal of members from the registers for not meeting the required professional standards or conduct.

A lot has changed over the last 60 years, meaning that aspects of the current Veterinary Surgeons Act are outdated and in need of review.  This is something the RCVS had been working on well in advance of the CMA investigation with a lot of controversy amongst veterinary surgeons regarding the recent decisions they have made and the proposed changes they plan to make to how the RCVS is governed in the future.  A few examples are listed below:

1. In 1999 a change to the Veterinary Surgeons Act was made to allow ownership of a veterinary practice by a non veterinary surgeon.  This enabled corporate groups to own and start buying veterinary practices.  The regulatory framework relating to veterinary practices only holds veterinary surgeons responsible for how a veterinary practice is run… If a veterinary practice is owned by a non-veterinary surgeon, the owners of the practice have no professional obligation or accountability to provide the correct facilities, which has the potential to cause conflict between a veterinary surgeon and their professional duty to the welfare of animals under their care and their employer who ultimately pays their wages.  It is likely that one of the recommendations of the CMA investigation is to make the current RCVS Practice Standards Scheme compulsory.  Currently it is a voluntary scheme that practices join to show that they meet the standards expected.  For independent, veterinary owned practices this is a professional obligation and by making the scheme compulsory it will simply lead to more time and costs being channelled away from caring for animals into unnecessary administration, the cost of which will ultimately be carried by the pet owner.  This would, however, provide a compulsory standard by which corporate practices must operate.

2. In September 2023 the RCVS updated the code of professional conduct relating to ‘Under Care’.  This allows for prescription products to be prescribed by veterinary surgeons without a physical examination at a veterinary surgeons professional discretion, opening the door to telemedicine.  This was trialled during covid where self isolation requirements prevented the ability of clients to travel to veterinary practices for routine appointments.  While this was essential during covid, many practitioners found that video consults and phone consultations lead to increased risks of misdiagnosis or delayed diagnosis with potentially inappropriate prescriptions being provided that are not always in the best interests of the welfare of the animal.  Further to this, control drugs and antimicrobial drugs (including parasite treatments) were specifically excluded from remote prescription. Veterinary surgeons have been specifically told that a physical examination is required for prescription flea and worm treatments.  Where previously a practice may have seen a dog for a sore leg 2 weeks previously and had a full physical examination, unless parasite treatment is prescribed during that consultation, if the owner subsequently notices fleas, prescription flea treatment can no longer be provided without another physical examination.  This has put extra strain on the existing veterinary workforce, the cost of which is ultimately passed on to the client.

Unfortunately over the last few decades it appears to me that the RCVS are more focused on the public perception of their regulation rather than upholding standards of care with respect to health and welfare of animals.  In my opinion, focusing on ensuring appropriate standards of care are being upheld by the profession would in turn demonstrate to the public that the profession is being appropriately regulated.  In order to do this the RCVS need to listen to what their members are telling them.

There is currently a consultation ongoing by the RCVS looking to reduce the number of veterinary surgeons involved with the regulation of themselves, in favour of more lay people.  They are also looking to remove the ability for veterinary surgeons to vote for colleagues that understand the complexities involved with the diagnosis and treatment of veterinary disease and its financial impact on their clients.  This would be replaced by appointing the governing board… how this would be done has not been disclosed but could potentially open the door to corporate directors with a commercial interest in the profession, rather than the veterinary surgeons whose professional oath it is to safeguard the welfare of the animals under their care.

The focus of the CMA appears to be on the RCVS, their regulatory framework and their ability to function as a regulatory body.  Although this is in need of review, the RCVS has no jurisdiction over the commercial aspect of veterinary medicine.  There is another regulatory framework that vets have to follow that has a larger impact on the cost of veterinary medicines and whose legal framework must also be incorporated into the RCVS guide to professional conduct.

The Veterinary Medicines Directorate (VMD) is a government department established in 1989 and has an important role in licensing veterinary medicines, ensuring they are safe and effective and are involved in enforcing the Veterinary Medicines Regulations.  While most of the regulations are there to protect the welfare of animals, some of them are very detailed and create no room for common sense to prevail in individual circumstances, protecting the pharmaceutical industry profit margins far more than those of veterinary practices. This can create unnecessary professional and regulatory conflict for the veterinary surgeon trying to provide the best care possible for their patient, while also following the regulatory framework to avoid disciplinary action or criminal charges. The following are examples of the regulatory framework controlled by the VMD that I feel limit a veterinary surgeons ability to provide cost effective treatment to their clients the most:

1. The Veterinary Cascade

This means that a veterinary surgeon must first use a product licensed for a particular condition in the particular species being treated.  If no such product exists, a product licensed for a different condition or species (other than human) must be used.  If no such product exists, a human product may be used and if still no such product exists, a veterinary surgeon can utilise drugs that are not licensed at all, but made by a compounding pharmacy or themselves.

This is a very reasonable system to safeguard the welfare of animals, ensuring products that have been professionally researched and licensed are used first.  Unfortunately, we are specifically advised that cost is not a justification for moving down the cascade, so if a licensed drug is incredibly expensive and an equivalent human drug is not, we are not legally allowed to prescribe it on cost basis alone.  In some cases a veterinary licensed drug will be significantly more expensive than a human drug containing exactly the same active ingredients.  This means that in some cases a client has the option of expensive treatment that cannot be afforded or no treatment, even though the veterinary surgeon is aware of an unlicensed treatment that is likely to improve that animals quality of life.

2. Veterinary practices can only sell drugs purchased from a veterinary wholesaler

This means that if a veterinary practice can purchase a drug cheaper through an online pharmacy, they are unable to do so and sell it on.  There are some occasions when prescription medicines are available cheaper at online pharmacies than veterinary practices can purchase through their veterinary wholesalers yet do not have the freedom to do so, meaning that veterinary practices are sometimes unable to compete with internet pharmacies.  The pricing and discount structure of veterinary medicines is a massive area that the CMA need to be looking at to allow fair competition between independent and corporate practices but does not yet appear to be on their radar.

3. Veterinary surgeons face criminal charges for recommending over the counter human products

The latest Veterinary Medicine Regulations 2024 now make it a criminal offence for a veterinary surgeon to encourage clients to utilise human over the counter products where appropriate.  There are instances where human over the counter products would be in an animals best interest and can be legally prescribed under the veterinary cascade.  Veterinary surgeons now face criminal charges should they advise clients of this and must either provide a written prescription for these products or dispense them from their practice (both options are likely to be significantly more expensive than simply advising the client what they can get off the shelf from a supermarket or pharmacy!)