VN 10. Consumer rights and freedom of choice

Introduction

10.1   In order to support consumer choice, veterinary surgeons and veterinary nurses should ensure that clients have access to sufficient information regarding a range of options for obtaining veterinary services, including the costs involved.

General

10.2  Veterinary surgeons and veterinary nurses are personally accountable for their professional practice and should always be prepared to justify their decisions and actions. In relation to consumer rights and freedom of choice, this means that veterinary surgeons and veterinary nurses should:

a. ensure that a range of reasonable treatment options are offered and explained, including the costs of each, taking into account the needs and circumstances of the client;

b. recognise the need, in some cases, to balance what treatment might be necessary, appropriate or possible against the circumstances, wishes and financial considerations of the client. Whatever the circumstances, the overriding priority is to ensure that animal health and welfare is the priority;

c. facilitate a client’s request for a referral or second opinion and recognise when a case or a treatment option is outside their area of competence (see Supporting Guidance Chapter 1)

d. not obstruct a client from changing to another veterinary practice, or discourage a client from seeking a second opinion;

e. make decisions on treatment regimes based first and foremost on animal health and welfare considerations, whilst providing contextualised care and exercising professional judgement about what is best for the animal in each individual case, taking into account the needs and circumstances of the client. For more information please see the RCVS Knowledge’s guidance on contextualised care;

f. where organisational protocols are in place, consider whether applying these in each individual case is appropriate.

See Chapter 2, paragraphs 2.1-2.2 for further information.
 

Veterinary medicines

10.3  In relation to veterinary prescriptions and dispensing of veterinary medicines, veterinary surgeons and veterinary nurses must:

a. ensure clients are able to obtain medicines by dispensing at the practice or, if to be dispensed elsewhere, via written prescription, as appropriate. A veterinary surgeon may only prescribe a Prescription Only Medicine, Veterinarian (POM-V) following a clinical assessment of an animal under their care. A written prescription may not be appropriate if the animal is an in-patient or immediate treatment is necessary;

b. subject to any legal restrictions, ensure there is adequate provision of information on medicine prices;

c. provide the price of any relevant veterinary medicinal product stocked or sold, to clients, or other legitimate enquirers, making reasonable requests;

d. inform clients of the price of any medicine to be supplied, prescribed or dispensed;

e. where possible and relevant, inform clients of the frequency of, and charges for, further examinations of animals requiring repeat prescriptions;

f. provide clients with an invoice that distinguishes the price of relevant veterinary medicinal products from other charges and, where practicable, provide clients with an invoice that distinguishes the price of individual relevant veterinary medicinal products;

g. advise clients, by means of a large and prominently displayed sign, or signs, (in the waiting room or other appropriate area), with reference to the following:

n.b., Where there is no physical building in which to display a sign, for example ambulatory or remote services, this information should be displayed clearly on the practice website and communicated to clients via other appropriate means, e.g., by email. 

h. provide clients with a written version of the information set out in the sign, or signs, referred to in paragraph 10.3(g), which may be set out on the practice website. Practices may also wish to communicate this information by other appropriate means, such as by email, leaflets or client letters. This information should be provided to new clients at registration and to existing clients on an ongoing basis while they are a client of the practice.

10.4  A reasonable charge may be made for written prescriptions; such prescriptions for POM-V medicines may be issued only for animals under the care of the prescribing veterinary surgeon and following their clinical assessment of the animals.

10.5  In relation to fees charged for other goods and services, a veterinary surgeon must not discriminate between clients whose medicines are dispensed via the practice and those who choose to buy medicines elsewhere via a written prescription.

10.6  A veterinary surgeon should not prevent a client from using the medicines retailer of their choice. Written prescriptions should not contain any specific recommendations of medicines retailers. If specific recommendations are given to clients by other means, however, veterinary surgeons should be able to justify their recommendations and where the veterinary surgeon or their employer has a financial or commercial interest in the medicines’ retailer, this should be drawn to clients’ attention.

10.7 Veterinary surgeons may wish to advise clients who are considering obtaining medicines from an online retailer of the Veterinary Medicines Directorate’s Register of Online Suppliers of veterinary medicines.

Note: ‘Prescription-only veterinary medicine’ has the same meaning as a medicine under the category of POM-V in the Veterinary Medicines Regulations 2013 (as amended).

Fees (estimates, discounts, animal insurance)

10.8  Veterinary surgeons and veterinary nurses must provide clients with relevant information in relation to fees. This includes (but is not limited to):

a. The costs of medicine;

b. The estimated cost of a range of relevant procedures and tests;

c. The provision, initial cost, and location of the 24/7 emergency first aid and pain relief/follow up service.

10.9  Fees may vary between practices and, in addition to factors such as facilities, services and 'out-of-hours' arrangements, may be taken into account when a client is choosing a practice. It may therefore be helpful to explain to clients, and prospective clients, the factors that influence the determination of the level of fees.

10.10 Pricing practices should comply with the Consumer Protection from Unfair Trading Regulations 2008 and other consumer protection legislation and should not be false or misleading.

10.11  Veterinary surgeons and veterinary nurses should be open and honest about fees for veterinary treatment. Clients should be provided with clear and easy to understand information about how fees are calculated and what it is they are being charged for. Clients should be furnished with sufficient information about the fees associated with treatment to be in a position to give informed consent to treatment.

10.12  A discussion should take place with the client covering a range of reasonable treatment options and prognoses, and the likely charges. If the animal is covered by pet insurance, it is in the interests of all parties to confirm the extent of the cover under the policy, including any limitations on cost or any exclusions which would apply to the treatment proposed. Insured clients should therefore be advised to contact their insurers to verify their cover at the earliest opportunity.

10.13  Veterinary surgeons and veterinary nurses should offer clients realistic estimates of the cost of the anticipated treatment based on the best information available at the time and before treatment commences. Where consent forms are used, it is recommended that the estimate should be included before the client provides written consent.

10.14  Veterinary surgeons and veterinary nurses should inform clients that estimates may be exceeded due to the unpredictable nature of clinical work. If the estimate is to be exceeded, the client should be contacted at the earliest opportunity for additional consent to be obtained and recorded in writing.

10.15  Discounts (e.g., for staff, students/pensioners) are generally acceptable and are a commercial decision by veterinary practices. However, it is never acceptable to present a client with inflated fees so as to create the fiction of a discount. Where used, discounts should be clearly recorded and transparent.

10.16  All invoices should be itemised showing the amounts relating to goods including individual relevant medicinal products and services provided by the practice. Fees for outside services and any charge for additional administration or other costs to the practice in arranging such services should also be shown separately. See Chapter 9 for further information.

Referrals and incentives

10.17  All referrals should be in the animals’ best interests. Veterinary surgeons and veterinary nurses who have referral-based incentives available to them should consider whether the existence of the incentive gives rise to a real or perceived conflict of interest, and if so, clients should be informed.

See Chapter 1, paragraphs 1.8-1.9 for further information.

Advertising and recommendations

10.18  Where veterinary surgeons recommend veterinary products and services in the course of treatment or when providing other veterinary services to clients (including by way of referrals and second opinions – please see Chapter 1), this recommendation should be clinically justified, i.e., based on sound scientific principles or have a recognised evidence base, and be in the best interests of the animal.

10.19  Veterinary surgeons should not allow any interest in a particular product or service to affect the way they prescribe or make recommendations. This is the case whether the interest is held by the veterinary surgeon themselves, their employer, or any other organisation they are associated with. Veterinary surgeons should inform clients of any real or perceived conflict of interest.

10.20  All advertising and publicity in relation to practice information and fees should be professional, accurate and truthful, and should comply with the UK Code of Non-broadcast Advertising, Sales Promotion and Direct Marketing (CAP Code). Any price comparison should be accurate.

10.21  A veterinary surgeon or group of veterinary surgeons should not enter into any agreement that has the effect of fixing fees. The Competition Act 1998 prohibits anti-competitive agreements, meaning businesses must not agree to fix prices or terms of trade, and must not agree price rises with competitors.

See Chapter 23 for further information.

Informed consent

10.22  Informed consent, which is an essential part of any contract, can only be given by a client who has had the opportunity to consider a range of reasonable treatment options (including euthanasia and the option to monitor the animals without further tests or treatment), with associated fee estimates, and had the significance and main risks explained to them.

10.23 In all cases, unless it would cause a delay that would adversely affect the animal’s welfare (i.e., in an emergency) the client’s consent to treatment must be obtained. For non-urgent procedures, where possible, the consent discussion should take place in advance of the treatment.

10.24 The following matters should be included in the consent conversation to maintain the client’s freedom of choice:

a.     A range of reasonable treatment options, being mindful not to make assumptions about the client’s financial constraints;

b.     The nature, purpose and benefits of any treatment or procedures;

c.     Financial estimates, and an agreement of financial limits. This should be documented on the client record.

See Chapter 11 for a full list of what should be included in a consent conversation and further information.