Veterinary Council clamps down on ‘helicopter’ vets

The Veterinary Council of Ireland has moved to “clarify standards” under its Code of Professional Conduct for Veterinary Practitioners in a bid to clamp down on the “confusing” and “non-prudent” supply of prescriptions on farms.

Under the recently-backed clarification, and in line with ethical guidelines, it is now expected that a vet (or registrant) should carry out a prior clinical examination of no later than 30 days before prescribing a prescription-only medication.

Up until now, and in accordance with Animal Remedies Veterinary Practice and Veterinary Medicine Regulations, any vet could provide a prescription for such medicines having visited a holding just once over the previous 12-month period.

Speaking to AgriLand, Peader Scanaill, the president of the Veterinary Council of Ireland, stated that the clarification was needed in response to concerns that “a small number” of vets had been “misinterpreting” the dispensing conditions as laid out in the regulations.

He outlined that the aim of the revision is to illustrate that a farm’s primary provider of veterinary services is the most suitable individual to prescribe medications, as that individual will have the most direct working knowledge of the holding, its disease threat, plus an understanding of any likely problems that could ensue.

Leeway

However, he added that in such situations where a primary vet is acutely up-to-date and familiar with the health status of a particular farm “more leeway” would be given allowing the vet to make a judgement call without needing to carry out a prior examination.

“We expect that before any prescribing be done that a prior clinical examination should occur. Before you prescribe any medicines you have to ascertain what the problem is that you’re prescribing.

“However, where there is in existence a relationship where you are the primary vet on the yard, or for a flock of animals, then it is understood that there would be more leeway given because of your knowledge of the farm or holding, knowledge of animals, and knowledge of the diseases under which they are challenged.

“In other words if you had no knowledge of the farm and you don’t have an arrangement with the farmer that you are the primary vet, then, if you are consulted, you are going to have to go and have a look – obviously,” he said.

He stressed that the amendment was a clarification to the code.

“We needed to clarify that where people seem to be losing their way a bit is that they focus on this ‘once-a-year’ reference in the regulation.

“So, even though there was no relationship as such and they didn’t really have any knowledge of the holding or the farm, except they visited the premises once a year, it became a free-for-all to supply.

“They were confusing supply with prescribing. ‘Once a year’ became a target; but it never was from a Veterinary Council perspective.

Making a diagnosis without actually examining the animal just prior would involve you having to know a huge amount of information around that animal.

“The situation couldn’t continue,” he said.

Scannaill stated that a limited number of vets were taking advantage of the wording.

“It was only with a small number of registrars, very, very small, but they were supplying extraordinarily large amounts of medicines.

“In particular, and where the real focus comes on, is that all antibiotics are prescription-only medicines so you cannot get an antibiotic for an animal except it is prescription supplied.”

Antimicrobial resistance

Because of the worldwide phenomenon and massive challenge in both human an animal health associated with antimicrobial resistance or antibiotic resistance, Scanaill said the situation couldn’t continue.

“It was clear that this small number of registrants that are supplying extraordinarily large amounts of products – including antibiotics – couldn’t continue.

“Clarification was required – it’s not a change; its a clarification of what we would expect a registrant to be doing,” he said.

However, taking into account that there are eight million cattle and four million sheep in the country; Scanaill said there will be a little latitude for primary providers of veterinary services.

“To go out to a farm every single time is grossly unrealistic, so in fairness if you have a working knowledge of the farm, and you have been there sufficiently and you’re satisfied and you’ve taken enough samples and you have the results of those samples and you know what challenges are going on from year to year, then you would be in a position to prescribe.”

However, in light of the antimicrobial resistance challenge, Scanaill says a primary care provider wouldn’t want to let it go much more than 30 days.

30 days

“What we’ve said is 30 days, but is not a target. It is a clarification of what is expected of a veterinary practitioner before they prescribe a prescription-only medicine for an animal under their care.

“Otherwise you couldn’t be certain that it is the same bacteria or the same disease.

“These people do exist who are visiting these farms and what we’re saying is they are the people that have the leeway to make judgmental decisions based on their knowledge – not the helicopter person that is coming in once a year, and going off again and has no working knowledge of the farm – that person was never the person that was intended to be prescribing.”

He stated that the Department of Agriculture, Food and the Marine and various stakeholders have been informed of the revision to the code. It is expected that vets will receive communications on the update over the coming weeks.

Scanaill emphasised that the clarification is not about piling additional costs onto the farmer, adding that the code will continue to be updated.

“It’s not to cause an increase in cost, it’s to cause prudent use of antimicrobials in particular and to restrict the prescribing without a prior clinical visit.

‘Biggest single threat’

“We will update the code until we see a pattern that antimicribials are being prescribed very prudently because we felt they were being prescribed in a non so prudent manner.

“Tackling antimicrobial resistance is the very, very top of the focus in every single thing we do in relation to antibiotics and in every single thing we do in animal care.

“Antimicrobial resistance is the biggest single threat to mankind in relation to health going forward.

Certain antibiotics in the future will not be available to vets or to animal owners if the human medics say they need to restrict them for human use only.

“So if we’re not careful, and if we don’t really, really be certain that we need that product, for that animal, at that correct dose, on this particular time, or if we abuse them or overuse them in any way they will be removed from us a product,” he said.