Prescription/supply of antiparasitics - updated September 2023

Back in March, the RCVS Council approved changes to its guidance on prescription of POM-V's to an animal that is "under care" of a veterinary surgeon: these will come into effect on 1st September 2023.

On the face of it, the main change to the guidance was mostly focused on physical examination of animals under the care of a veterinary surgeon.

The guidance changed from:

A veterinary surgeon who has an animal under their care should have a 24/7 facility to physically examine the animal or visit the premises in the case of production animals, farmed aquatic animals and game.

to

A veterinary surgeon who has an animal under their care must be able, on a 24/7 basis, to physically examine the animal or visit the premises in the case of production animals, equines, farmed aquatic animals and game.

Where a veterinary surgeon is not able to provide this service, they must make arrangements for another veterinary service provider to do so on their behalf, details of which must be provided to the client in writing in advance of providing veterinary services.

The amended guidelines maintain that the prescription of antimicrobials and controlled drugs requires a physical examination in all but exceptional circumstances, but clarify that for antimicrobials, this applies to all except production animals, farmed aquatic animals and game.

However, interpretation of "antimicrobials" has also been changed, to adopt a definition used by the World Health Organization as "including antibiotics, antivirals, antifungals and antiparasitics".

This change means that vets prescribing POM-V antiparasitics for equines and companion animals are required to have conducted a physical examination of the animal(s).

We're getting some feedback that animal owners may have read about this, from their veterinary practice or elsewhere, and misunderstood the consequences.

There is no change to the legal requirements around prescription and supply of POM-VPS and NFA-VPS antiparasitics by RAMAs/SQPs - or indeed by vets or pharmacists.

As prescribers/suppliers of VPS medicines, the legal and professional duties of RAMAs/SQPs remain as set out in the Code of Practice - paragraphs 30 to 41. While a physical exam is not expected, complying with the obligations in the Code of Practice continues to be required.

UPDATE, September 2023

Since the draft guidance was published as part of the consultation, the Standards Committee has agreed some minor amendments to the wording.  The RCVS initially adopted the WHO definition of antimicrobials which includes antiparasitics, but following the change there is no longer reference to ‘antimicrobials’. Instead, the guidance refers to ‘antibiotics, antifungals, antiparasitics and antivirals’. The updated guidance, the implementation of which has been delayed until 12 January 2024, together with some additional resources, can be found on the RCVS website.

It is worth noting that POM-VPS medicines are outside the scope of the guidance as it only relates to prescription of POM-Vs. As such, there is no requirement for a veterinary surgeon to carry out a physical examination before POM-VPS medicines are prescribed (although of course these should be prescribed responsibly and in line with the requirements of the VMRs and, in the case of AMTRA RAMAs/SQPs, the SQP Code of Practice).

AMTRA is in discussions with RCVS to obtain further clarity and understanding around the RCVS narrative for their under care guidance and prescribing.  AMTRA would like to work towards a holistic solution to the contention within veterinary paraprofessionals including SQPs (particularly those fulfilling their role within clinical practice) and vets relating to the prescribing of certain classes of medicines to ensure a synergy for good prescribing practice and behaviours by all without creating ‘prescribing silos’.