[The following article was scheduled to be published in the Veterinary Times in January 2013. It was withdrawn due to the RCVS hearing.]

The Balance of Professional Regulation

Regulatory bodies receive scant praise or appreciation from their respective professions and the veterinary sector is no different. The Royal College of Veterinary Surgeons (RCVS) will probably never be popular amongst the majority of UK vets, because of its stance in both regulating them and at times prosecuting vets. The fact that the RCVS extracts funds from vets for a licence to practice also doesn't help the situation, although the RCVS has no alternative so long as it wears both the licensing and disciplinary hats - neither of which is fashionable among UK vets. When I stood for RCVS Council in 2006 I had attempted to change the perspective a little, suggesting that the two sections of the RCVS mission statement might be re-prioritised ie. placing the importance of advances in Veterinary Medicine above the regulation of vets.

Interestingly, without a regulator any profession holds less credence in the public eye, and this was recently demonstrated in public surveys published by Ipsos MORI and Which? Nurses and doctors were found to be the professions that were most trusted by the public, whilst bankers, politicians and journalists were the least trusted. So, what of the role of the RCVS? Can it be improved, or do UK vets really care so little for the RCVS that it makes no difference what the RCVS does? Will the RCVS card always be negatively marked? The RCVS has attempted to improve the level of voting amongst its electorate, but annually approximately only 18% of vets vote in the RCVS elections, and an election where 18% of the electorate vote is not reflective of practitioners' opinion. Yet does a regulator actually need to listen to its practitioners' opinion? The RCVS mission statement focuses upon public opinion and public opinion remains separate from the opinion of RCVS practitioners. This clear distinction continues to place the RCVS at odds with its membership. An example of the disparity can be seen in the disciplinary process, where the RCVS Disciplinary Committee is comprised of increasingly more lay members and less veterinary members. RCVS members would point out that this constitutes a regressive move, becoming increasingly dismissive of the clinical experience and veterinary sector understanding of practitioners: vets would generally reject the expense and question the effectiveness of training lay committee members, since these measures have been instituted to demonstrate to the public that the RCVS disciplinary committee does not hold a professional bias. Politics will continue to pit the interests of opposing factions against each other, and the balance will continue to swing in different directions so long as the factions hold different objectives. The question remains though as to exactly where the overall balance currently lies within the veterinary sector?

A veterinary regulator remains necessary in today's world, not only to uphold standards, but more interestingly to protect veterinarians against some of the inherent injustices that occur within the veterinary sector - this suggestion requires an explanation. Most vets will hope that their dealings with the RCVS will be minimal, because dealings with the RCVS usually mean bad news for a veterinary practitioner. Some vets may believe that any complaints lodged against a practitioner are self-inflicted since excellent vets never receive complaints against their name. Subjectively that view remains naive. The world is never perfect and injustices will always remain a part of reality. Whilst veterinary prosecutions clearly justify the salaries of RCVS lawyers, prosecutions can and do destroy veterinarians' careers and on occasions do so unjustly. The 'tarnished' can respond with their own websites (or other measures) with varying degrees of success. Subjectively I do see mileage in veterinary businessman protecting their reputation and commercial livelihood with the means that remain available. However what I cannot subjectively condone, is veterinarians assisting in the destruction of another colleague's career, and the best way to prevent this is through the RCVS legal channels. Whilst veterinarians might unfortunately be lumbered with lawyers within the RCVS, at least we should ensure that the relevant laws discourage vets from attacking each other, and afford RCVS members due legal protection against dishonest acts such as supersession. For example, the veterinary sector isn't propped up by an equivalent of the NHS with its central funding, and this means that vets inherently and commercially compete with each other, especially where the number of practitioners is increasing within the UK. It's not a coincidence that vets have the highest suicide rate of any UK profession, facing both clinical and business pressures in veterinary life. Under pressure different vets will behave differently and whilst the RCVS doesn't wish to become involved with business matters, a position of non-intervention is becoming increasingly untenable. Veterinary practitioners can only operate within the bounds of the laws that are in place for them and laws can be used to protect the vets who remain honest and honourable. The RCVS previously upheld unethical and immoral acts of supersession between practices. Many practitioners will know or will have heard of a colleague who has either committed suicide or has been subjected to immoral commercial dealings from within the veterinary sector. This reality sours the vocation of a veterinary practitioner but this doesn't need to be a reality.

We've heard the arguments made by RCVS lawyers in favour of swinging the balance away from veterinarians: perhaps now is the time to redress the continual movement away from the interests of vets and to consider reforms that will restore a better balance before it becomes too badly skewed against practitioners. It always remains possible to change the RCVS from within so long as there is sufficient advertisement, sufficient discussion and sufficient proactive lobbying that calls for constructive change. The nature of any change within the RCVS will inevitably be a matter of debate, but a few possible proposals are suggested below to correct the current bias against practitioners and to pull the RCVS back towards assisting veterinarians (as well as regulating them). Such proposals might include:

1. A net transfer of executive authority from RCVS lawyers back towards veterinarians;
2. Implementing transparent accountability for RCVS lawyers and RCVS employees;
3. Proactive balloting of RCVS membership upon matters of veterinary regulation;
4. Elections for the RCVS Registrar, who would hold office over a fixed term;
5. Protecting veterinarians' careers by publishing only proven disciplinary charges;
6. Proactive implementation of RCVS measures to combat supersession and to combat similar un-ethical behaviour between practitioners or practices;
7. Implementing financial penalties against malicious or spurious complaints made by members of the public against veterinarians, similar to the system employed for the processing of complaints made against the police.

A recently mooted approach by the RCVS has been to improve its regulatory function via the introduction of a Legislative Reform Order. The Legislative Reform Order (LRO) has become the substitute for a new Veterinary Surgeon's Act, which reportedly had little chance of being considered by parliament. The key thrust of the LRO is to separate the disciplinary arm of the RCVS from its law-making arm, which in turn requires additional personnel to perform these functions separately. Unfortunately the RCVS will still be associated with the unpopular duty of prosecuting vets, and RCVS membership subscriptions may rise to accommodate the added expense of extra RCVS personnel and the training of lay staff. The increased size and number of RCVS prosecuting committees is correlated with the increased number of prosecutions levied against RCVS members: there is also a relationship between economic downturns and the level of public complaints made against medical practitioners. Whilst the RCVS has outlined the increased size of its prosecuting committees, it has not reported considering attempts to reduce the level of public complaints, for example by implementing (7) above, and also (1), (2) and (6). The RCVS has reported a perceived benefit in reducing the turnaround time for veterinary prosecutions: however, veterinarians can continue to practice prior to RCVS hearings, so the perceived benefits are not evident. The RCVS recently commissioned an Edinburgh professor to investigate why vets have the highest level of professional suicides. The investigations did not investigate the impacts of (1) to (7) above upon suicides within the veterinary sector. With careful forethought the regulatory functions of the RCVS need not be perceived by veterinarians as having only a negative impact upon their profession. However, to achieve a more positive perception amongst veterinarians, the RCVS would have to tackle the currently imbalanced issues that attack RCVS members, and the RCVS would also have to shun self-interest.

Dr. Marcus Hutber BSc,MA,DVM,PhD,MRCVS