The RCVS has updated its guidance on the referral process, have you seen it? It’s largely a clarification of the previous guidance but there are some new bits and it does make it clearer what the RCVS expects of vets making referrals.
There are four main areas relevant to any colleague referring a patient:
Making referral recommendations to owners
The RCVS makes it clear that it is not appropriate to refer to a colleague without advising the owner of the level of expertise of that colleague, and this must be done using defined terms (such as Advanced Practitioner, RCVS Specialist). The referring vet must also offer options for the owner and explain different levels of expertise. So, for example, it is OK to refer to a peripatetic Advanced Practitioner but the referring vet must explain that they are an Advanced Practitioner and not a Specialist and that referral to a Specialist is also an option (Specialist meaning someone on the RCVS list of Specialists). The guidance also states the referring vet should explain the difference between the two and what sets them apart (more on that below).
Describing referral surgeons
The RCVS makes it clear that only recognised titles should be used when describing referral clinicians -for example Advanced Practitioner, RCVS Specialist. It is considered misleading and therefore inappropriate to refer to a colleague as a ‘consultant’, ‘referral surgeon’, ‘orthopaedic surgeon’ or other such similar term. These have no meaning in relation to a clinician’s expertise or qualifications and to an owner imply a level of expertise that that clinician may not have.
Referring to a referral centre rather than a specific colleague
This part is new guidance. When referring to a referral centre the referring vet should inform the owner of the different levels of experience of vets working in that centre. This makes sense; after all an owner may be referred to ‘Joe Blogs Veterinary Specialists’ and therefore assume they will see a Specialist but actually have their pet treated by a resident with no specialist qualifications.
Conflicts of interest
This is not new guidance but it is something that I believe a lot of vets are not aware of. The guidance states ‘When referring cases veterinary surgeons should explain any links to the referral practice that could be considered a conflict of interest, including where the practice being referred to is owned by the same group’ and also ‘Veterinary surgeons and nurses should inform clients of any real or perceived conflict of interest in relation to recommendations in the course of treatment, which includes referrals.’ A conflict of interest should therefore be disclosed to owners in situations such as a referral to a referral centre in the same group, referral to a peripatetic surgeon employed by the same group and referral to a freelance peripatetic surgeon working out of your own practice (the latter because the practice will keep a significant proportion of the income from that referral).
Why has the RCVS updated the guidance?
There’s been a growing concern that the previous guidance was either not fully understood or was often ignored and that vets needed clarification of what the RCVS expects to ensure owners can make the right decision for their pet. Ignoring the guidance can have very real consequences. I see cases on a relatively regular basis that have had prior treatment by a non-specialist and where there have been errors in treatment and/or complications which in some cases can have serious welfare issues for the pet involved. Often when this happens the owner is angry that it was not explained to them that the original surgeon was not a Specialist. In this particular scenario our GP colleagues should be aware that from the RCVS’ perspective it would be the referring vet who is at fault for not offering other referral options, not the non-specialist surgeon (as long as they were not misrepresenting themselves as a Specialist).
The differences between Certificate holders/Advanced Practitioners and Specialists are not minor. In relation to surgery, only Specialists have completed three-years of full-time surgical training under another Specialist, have completed a case log documenting a required number of different surgeries and have then passed a Diploma level examination. To become a Specialist means having been trained and assessed to a far higher level than a Certificate holder or Advanced Practitioner.
The profession is under more scrutiny than it has ever been before. Vet-bashing articles in the mainstream media are sadly not uncommon. We all know about the CMA review and their concerns that owners are not getting the information they need when making treatment decisions for their pet. In this wider context it is really important that we are all completely transparent with owners. The CMA will be looking at the referral process and the RCVS are to be applauded in trying to make referrals more transparent for owners ahead of that review. This is good for the profession, good for owners and most importantly good for pets.
The new guidance does, however, put the onus very squarely on the referring GP vet to be clear and transparent with owners when advising referrals. We recognise that this is not always easy when you’re already short of time. Rest assured that when discussing The Moores Orthopaedic Clinic with your clients, you can tell them confidently:
• Their pet will always be treated by an RCVS Specialist surgeon
• We are independent; there are no conflicts of interest
• Our pricing is fair and transparent and is visible to everyone on our website
The RCVS’ summary of the new guidance can be found here: https://www.rcvs.org.uk/news-and-views/features/standards-and-advice-update-august-2024/?utm_source=informz&utm_medium=email&utm_campaign=rcvs
Andy Moores BVSc DSAS(Orth) DipECVS FRCVS
RCVS Specialist in Small Animal Surgery (Orthopaedics), EBVS European Specialist in Small Animal Surgery
