Assuring Practice Regulation

The working group looking into assuring practice regulation were tasked with considering the following recommendations:

• Recommendation 3.1: Mandatory practice regulation
  • The RCVS be given the power to implement mandatory practice regulation, should RCVS Council decide to replace or underpin the PSS with a more comprehensive scheme.

• Recommendation 3.2: Powers of entry for the RCVS
  • RCVS be given powers of entry into order to remedy this omission in the veterinary sector, and to ensure that mandatory regulation of practices can be underpinned and enforced.
    
    
• Recommendation 3.3: Power to issue improvement notices
  • Introduce a power to issue improvement notices when a person or a business is failing to fulfil a legal duty and improvement is required to ensure future compliance

Mandatory practice regulation?

In contrast with other sectors, the veterinary profession in the UK does not have a body for regulating veterinary practices. The Care Quality Commission fulfils this role in human health care but is separate to the General Medical Council who regulates individual doctors for example. We must, however, be cautious when comparing the human health care sector with the veterinary sector: the business models are not comparable, and the establishment of a CQC like body in the veterinary profession would not only likely be cost prohibitive, but also mean we are no longer a self-regulating profession. We must recognise there is a conflict with the current situation in the UK and public expectation - it is likely that the public already assume practices are regulated. Whilst there are plenty of voluntary schemes supporting practice standards overseas, there are few mandatory schemes, the exception being the Veterinary Council of Ireland who have had a mandatory scheme since 2007.

The voluntary RCVS Practice Standards Scheme (PSS) has over time developed into a more collaborative and positive process for those practices involved, with an overall aim of raising standards. Although many practices in the UK are part of PSS, it still leaves approximately 32% of practices not assessed by the scheme. It is likely most of these practices do in fact meet the core PSS standards (legal minimums), but with no assurance of this, how can it be said that the public and animal welfare are consistently protected?

However, the current system isn’t perfect, for example not all practices are eligible to join (for example certain specialist practices) and poor practice does continue in some accredited practices. There is also the question as to whether the scheme is able to address concerns related to animal welfare, and the underlying fear of the RCVS may also be preventing practices signing up. Which touches on a key consideration when it comes to regulatory reform of any type: if the aim is to foster a culture of care, then all systems put in place must be based on a supportive environment building on improving care, rather than focussing on punitive measures. It is right to say that over the recent years the PSS assessments have become a more collaborative and positive process, but the working group do have a concern that this may be lost and replaced with a more adversarial process if PSS were to become mandatory.

It is important to recognise that evidence that regulation improves quality of care is limited, and there is a risk the proposal of mandatory practice regulation ends up being regulation for regulations sake. The 2014 RAND Europe report that looked at health care regulatory systems in six countries found there is scare evidence to support regulation had improved quality of care, that evidence for specific interventions were weak, and that when looking as to whether inspections contributed to improvements in quality of care the evidence was inconclusive. Some studies noted negative impact of mandatory inspections. Practice regulation alone cannot and must not be seen as the panacea for improving quality of care and could in fact if implemented incorrectly result in a downwards spiral as practices chase inappropriate KPIs.

On balance, the working group supports the principle of the recommendation, but we would need the detail on the practical implementation. It is vital that practice regulation is part of a holistic approach alongside wider regulatory reforms. Regulation must make a positive impact on quality of care and must not be simply a tick box exercise. The success of any mandatory scheme will also be dependent on effective communication to members of the public, the vet-led team and the veterinary professions.

There are also other questions that must be addressed.

Firstly, how do we define ‘practice’? Is a veterinary surgeon acting as a consultant working out of their own home a practice? What about a peripatetic veterinary surgeon? The Veterinary Council of Ireland recognises four types of premises within their scheme, including the Registered Mobile Veterinary Unit, showing that defining a practice is difficult and goes beyond a physical building.

Secondly, despite all the regulatory reforms, there is a gap in the regulation of non-MRCVS that own practices. There appears to be no provision for the regulation of these individuals or companies, as the RCVS can only regulate MRCVS. When there are failings, it is rarely down to the individual alone, but often there are flaws in the system in which they are working that have contributed to this. The aim of practice regulation should include the creation of a means of recourse when there are failings in the system that do not sit with individuals, and the proposals for mandatory practice regulation do not address this.

Powers of entry?

The working group does not support the RCVS having powers of entry as it is an unnecessary overreach. For all serious cases and offenses, there are already other bodies that have powers of entry, for example the police and VMD, and so it is unclear what would be added by granting powers of entry to the RCVS. Mandatory regulation should be underpinned by short term interim inspections and the ability for the RCVS to close practices for non-compliance. If non-compliance with mandatory practice standards leads to the closure of a practice, which is an effective way of giving mandatory practice regulation the legal backing it requires, powers of entry feel like an unnecessary overreach. Powers of entry does not fit with the vision of a modern, compassionate regulator, and would likely perpetuate the culture of fear and undermine efforts of the RCVS to establish its vision.

Improvement notices?

Improvement notices are a proportionate way the RCVS could approach those practices failing to fulfil a legal duty, rather than the pursual of a disciplinary case. We support the principle of improvement notices and understand the need for them to uphold public trust as well as standards, but they must be underpinned with clear support and guidance on how to achieve improvements, and it must all be in a curative, not punitive environment. It is also important that there is a defined end point for improvement.

In summary, the group supports that principle of mandatory practice regulation, provided it is part of a holistic, curative, supportive culture, focused on care. The RCVS does not need powers of entry in order to achieve this and doing so would be an inappropriate overreach.

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