1. Executive summary
1. This report presents the findings of the RCVS Legislation Working Party (LWP). The LWP was established in 2017 with a mission to examine the Veterinary Surgeons Act 1966 (VSA), and to make proposals for reform to ensure that the RCVS can be a modern and efficient regulator.
2. The LWP was tasked to establish principles on which any reform would be based, and to ensure that any recommendations were considered in the round to produce a coherent vision. The LWP was specifically tasked with ensuring that consideration was given to a more comprehensive piece of legislation that could incorporate allied paraprofessionals and the regulation of veterinary practices.
3. The LWP consisted of a membership drawn from across RCVS Council, Officer team and staff, including veterinary surgeons, veterinary nurses and lay members, as well as representation from both the British Veterinary Association (BVA) and British Veterinary Nursing Association (BVNA). Over the course of three years and twelve meetings the LWP explored over 56 reform proposals, from fundamental questions to relatively minor changes.
4. Should council choose to accept them, all the recommendations in the report will be subject to consultation with the professions and the public. Some recommendations do not call for immediate change, but ask that the RCVS be given powers to be able to implement a particular measure in future should detailed proposals be developed and RCVS Council decide to implement them – with (where appropriate), the Secretary of State agreeing via an Order in Council[1] or other method. This future-proofing would remove the burden of additional Parliamentary time or other burdensome processes being required in future.
Key messages
The principles of legislative reform
5. The LWP established the following principles on which reform should be based:
Principle 1
Legislation should not be unduly burdensome or complicated; it should provide clarity to the public and enhance public confidence in the professions, e.g. protection of veterinary titles, statutory underpinning for continuing professional development (CPD).
Principle 2
The RCVS disciplinary process should be ‘forward looking’, with public protection at its heart.
Principle 3
That the vet-led team should fall under a single regulatory umbrella.
Principle 4
By default, acts of veterinary surgery should continue to be restricted to veterinary surgeons. However, in order to allow for futureproofing, there should be flexibility to reflect and review the procedures that may be delegated to appropriately qualified and supervised members of the vet-led team. Additional tasks may be delegated where this can be fully justified and evidenced. Such evidence may include comparison with other health professions.
Principle 5
Delegation rights to different paraprofessions should be variable without impacting each other. For instance, the rights of VNs to undertake minor acts of veterinary surgery should be amendable without impacting the rights of farmers as is the situation at present
Key recommendations
Embracing the vet-led team
6. The LWP defined the vet-led team as ‘appropriately-regulated professionals, including veterinary nurses, working under the direction of a veterinary surgeon, to protect animal health and welfare”. The RCVS is proud of its regulation of veterinary nurses, who play an essential part in the vet-led team, and the LWP is keen to allow veterinary nurses to expand their role. The LWP’s recommendations also build on previous work by the RCVS to call for additional paraprofessions to be brought under the RCVS’s umbrella – becoming ‘allied professions’ - to underpin their standards. The LWP proposes the adoption of a model of paraprofessional regulation similar to that of the General Dental Council, allowing the RCVS to regulate all members of the vet-led team, and to create greater evidence-led flexibility over what can be delegated to these allied professionals. The LWP recommends that statutory protection be given to the professional titles of all allied professions regulated by the RCVS, including veterinary nurses.
Assuring practice standards
7. The RCVS Practice Standard Scheme (PSS) has been very successful in promoting high standards within veterinary practice. However, it is a voluntary scheme and as a result there is no mechanism to ensure standards across all practices through assessments. At present the RCVS only regulates individual veterinary surgeons and nurses, unlike modern regulatory regimes such as that recently established for the General Pharmaceutical Council. Nor does the veterinary sector have an equivalent to the Care Quality Commission. The LWP recommends that the RCVS be granted statutory authority to regulate all practices. In order for practice regulation to be meaningful and enforceable across the board the RCVS would need powers of entry similar to those regulators.
Introducing a ‘Fitness to Practise’ regime
8. The RCVS’s existing disciplinary processes do not reflect modern best practice. The LWP recommends introducing a forward-looking ‘Fitness to Practise’ regime with less focus on past misconduct, instead introducing the concept of ‘current impairment’. This model would include the following: introducing a wider range of sanctions, including conditions of practice orders which would restrict practice short of suspension; introducing interim orders to allow vets and RVNs to be restricted from practising whilst cases are investigated where there is a significant risk of harm; introducing; and underpinning the Health and Performance Protocols in legislation. The LWP also recommends reforming the appeal processes so that they become the responsibility of the High Court rather than the Privy Council and introducing the power to require disclosure of information. The LWP further recommends reducing the Disciplinary Quorum to three, with flexibility to use a larger number of Committee members for longer or more complex cases.
Modernising RCVS registration
9. The LWP recommendations include a number of reforms to improve the RCVS’s registration processes that are not possible under the VSA. This includes the separation of registration and licence to practise, in line with other regulators, to underpin mandatory CPD and to enable the RCVS to introduce a revalidation regime (as found in other health professions such as the General Medical Council) if this was judged to be appropriate in future.
Improving access to the profession for those with disabilities
10. The LWP recommends the introduction of provisions for limited licensure in specific circumstances where disability would limit the ability to work in all areas of practice.
Retaining a Royal College that regulates
11. The LWP recommends that the RCVS continues to be a ‘Royal College that Regulates’. This unique arrangement allows the RCVS to take a holistic approach to public assurance. It also ensures that the Royal College functions are properly funded; some RCVS activities might well not be carried out at all if the RCVS did not take responsibility for them. These includes some Charter-based activities carried out as part of the proactive and supportive approach to regulation such as initiatives in the area of mental health and leadership.
Towards a new Act?
12. Many of the proposed recommendations require primary legislation. The number and scale of proposed changes, and in particular the proposal to embrace paraprofessionals by regulating the whole veterinary team, mean that it is unlikely that the LWP’s coherent vision for reform can be achieved in its entirety, or even substantially, via amendments to the Veterinary Surgeons Act 1966. While some recommendations could perhaps be implemented piecemeal via secondary legislation, any combination of these may well be too substantial a reform for this method of legislative change. The RCVS has done the best it can within the limits of the VSA since its creation in 1966, but the process of using creative solutions to mitigate the limitations of the Act, such as the health and performance protocols, may now be nearing its limit. The VSA is in many ways an old-fashioned piece of legislation, overly restrictive and prescriptive, burdensome rather than principles-based, and unfit to underpin the work of a modern regulator or a modern profession.
[1] A secondary piece of legislation approved by the Queen on the advice of the Privy Council