Many of you may be aware that as of 1st September 2023, the rules around vets prescribing medications in the UK have changed. Some of these changes are relatively minor, but others may have a substantial impact on how you see your vet and how often your animals need to be re-checked. The changes have also been very controversial within the veterinary community, so you may find different practices take very different approaches to the changes.

What has changed?

On 1st September, the RCVS – the UK’s veterinary regulator – changed the guidance in the Code of Conduct around prescribing of prescription-only veterinary medicines (POM-Vs). The law around veterinary medications, the Veterinary Medicines Regulations 2013, merely states that a “clinical assessment” has to take place before they are prescribed, so it is the RCVS who define what form that clinical assessment should be in – and this is the key change that has been made.

The change most likely to impact you is that prescribing of most POM-V medicines can now take place without the animal being seen – however, there are additional restrictions on some medicine categories, where the regulations are now being enforced more strictly. There are also specific safeguards to ensure that online or remote-only companies provide appropriate real-world care.

What was the old guidance?

For many years, the RCVS required that vets only prescribe prescription medicines to animals that they had physically examined “recently enough” to be confident of their clinical status. Depending on the disease condition and the medication, most vets interpreted this as about 12 months for “routine” medications like flea and worm treatments, or up to 6 months for other ongoing meds; but the rules were clear that the animal would usually need to be seen before any medications could be prescribed (although there were some differences for farm animal medications, where the herd might have been seen but not necessarily the specific animal).

So what changed?

A number of factors. Firstly, concerns had been raised that the original guidance, which specifically prohibited vets from prescribing if they had never seen the animal, was legally “problematic”.  

During the pandemic, “remote prescribing” – in other words, issuing prescriptions without physically seeing the animal – was temporarily permitted, for reasons of public health (an emergency decision I don’t disagree with, in principle). A large scale study by the PDSA concluded that this had not had a significant impact on animal welfare – earlier concerns had largely centred around the risks of misdiagnosis remotely, resulting in harm.

Finally, anecdotal reports suggested that some powerful prescription medications were not always being handled strictly in accordance with the law, in particular around ongoing flea and worm treatments using modern prescription-strength products.

So what does the new guidance say?

There are a number of changes to the new rules that you will probably notice in practice.

Most veterinary medicines can now be prescribed remotely 

This might be after, for example, a video call; or based on a phone call as a result of a change in your animal’s condition. However, it will depend on the circumstances. A vet is only permitted to prescribe without a physical examination of the animal if they are confident that they have enough information or knowledge to be sure that:

  • The risk of misdiagnosis or unwanted harm is minimal;
  • The risks to the patient and the owner from the medication are minimal;
  • The patient is not suffering from a notifiable disease.

This might include, for example, ongoing medications for a dog with stable skin disease, or a cat with hyperthyroidism with no change in status.

It is not, however, a right to have medicines prescribed without a vet visit

It is up to the veterinary surgeon to decide whether they can safely prescribe that medication to that patient at that time.

There are also specific exceptions around controlled drugs

For initial prescriptions of controlled drugs (like most anti-epileptics, for example, or some painkillers and tranquilisers), the patient must be seen at the time of prescribing. However, ongoing prescriptions for a period are permitted before the animal must be seen again. In a few situations the vet can prescribe small amounts of a medication without seeing the patient – for example, tranquilisers needed to get a fractious cat into the practice. In general, though, controlled drugs need physical examination before prescribing.

And the rules around antibiotics and antiparasitics are much stricter

For pet animals, the patient must be seen at the time of prescribing for any antibiotic or prescription antiparasitic treatment. While the rules are slightly different for farm animals, the same principles apply, in that the vet must have visited the farm and physically examined at least one representative animal recently enough to be able to prescribe safely. The only major exception is that if samples are taken that show the prescribed antibiotic is not suitable, the vet can prescribe an alternative drug based on the test result rather than having to see the animal again once the results come in.

What about flea and worm treatment?

This is where it gets complicated. The RCVS have defined “antimicrobials” to include prescription flea and worm treatments (following the World Health Organisation classification). This means that, to prescribe these products, the pet must have been seen by the vet, who then set down what drugs they were permitted to have. While repeat prescriptions are then permitted, if for any reason the client or the vet want to change to a different medication, a new visit and a new recorded prescription on the patient’s records will be required.

So, you may well find yourself having to get an unexpected check-up at the vets going forward if their old records weren’t compliant with the new rules, so they can log a new prescription!

HOWEVER, this part of the guidance has been delayed until 12th January 2024, to give practices time to ensure that they are compliant without adversely impacting animal welfare.

Does this make abuse by online-only companies easier?

That’s certainly a major concern among the veterinary profession. As a result, the RCVS have made it mandatory that vets prescribing remotely must be in a position to realistically either see the animal in person at their practice, or make a visit (for large animals). Alternatively, if they do not wish to do so, they must have a written contract with a vet local to wherever their clients are located to allow that vet to perform any emergency examinations or procedures for them.

Is this a good thing or not?

That’s a really interesting question! And the answer is that we don’t really know yet. However, assuming the PDSA’s figures were correct, it’s likely that once all the initial teething issues (and there will be some, probably lots!) are worked out, that it’s a net benefit to animal welfare.

But for right now, it’s pretty confusing for many of us, so please do bear with your vets as they make the adjustment and make sure that they are compliant with the new rules!