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Vets’ prescription charges will be a thing of the past

VETS WILL soon no longer be allowed to charge for writing prescriptions for medicines, the Government has ruled. This is one of the most radical shake ups to occur within the veterinary profession and comes at the end of a three year-long consultation; involving the Competition Commission, the Department of Trade and industry and official bodies representing the veterinary profession.

However, some observers within the industry have warned that the Government’s ‘tinkering’ with the existing system may end up costing pet owners more in the long run than if prescription charges did apply; as vets may be compelled to charge more for their professional services overall.

The Government has now published its response to the consultation on the draft Order implementing the recommendations of the Competition Commission in their 2003 report on the supply of prescription-only medicines for veterinary use (POMs).

In particular, the Government’s response accepts the proposal from the Royal College of Veterinary Surgeons that the majority of provisions that were subject to consultation can be implemented through amendments to the RCVS Guide to Professional Conduct.

The revised Order will therefore require:

Veterinary surgeons not to charge for writing prescriptions for three years;

Manufacturers of prescribed veterinary medicines to provide veterinary surgeons and pharmacists with information about the prices of prescribed veterinary medicines; and

Veterinary manufacturers and wholesalers to supply prescribed veterinary medicines to pharmacies and veterinary surgeons on the same terms for the same volumes supplied over the same time period.

The Final Order will need to reflect changes that are to be made in the forthcoming Veterinary Medicines Regulations, being prepared by the Department for the Environment, Food and Rural Affairs.

As these Regulations have not yet been published, no final Order can be laid at this time. However, the Government has produced some draft guidance that anticipates the Regulations.

Monopoly

The Competition Commission's report was published on 11 April 2003. The Commission found that three complex monopoly situations existed in relation to POMs.

The first complex monopoly situation involves veterinary surgeons engaged in one or more of the following conducts:

(a) Failure to inform animal owners that they can ask for prescriptions, or discouraging requests for prescriptions, or declining to provide prescriptions on request;

(b) Failure to inform clients of the price of POMs prior to dispensing them, or to provide itemised bills; and

(c) Pricing of POMs which does not reflect their cost of supply.

The second complex monopoly situation arises from the failure of eight manufacturers to enable pharmacies to obtain supplies of POMs on terms which would enable them to compete with veterinary surgeons.

The third complex monopoly situation arises from the failure of all the veterinary wholesalers to take reasonable steps to market to pharmacies and supply them with POMs, so that they can compete with veterinary surgeons.

The Government reviewed and accepted the Commission’s findings when the report was published.

Meanwhile the Royal College of Veterinary Surgeons has indicated plans to implement the Commission’s recommendations at the earliest opportunity through its Guide to Professional Conduct.

"RCVS Council decided that it would be better to include the recommendations in the Guide, where possible, rather than see them in legislation and I am pleased that we have been able to achieve this. This follows several years of discussion with government and other veterinary bodies such as the BVA," comments Stephen Ware MRCVS, Chairman of the RCVS Competition Commission Working Party.

Implementation through the Guide will be restricted to those elements of the draft order that increase the transparency of medicine pricing and the availability of prescriptions from veterinary surgeons.

Those recommendations to be included in the Guide will not be appear in the final Order put before Parliament and enacted. They concern the provision of information (written and verbal) on POM supply, availability and charging; the need to produce itemised bills to distinguish the costs of services from the cost of POMs; and guidelines on repeat prescriptions.

To make such additions workable, the Guide will be modified to remove the current restrictions on vets publishing prices for veterinary medicines.

"More straightforward language can be employed in the Guide than in an Order, allowing, as elsewhere in the Guide, for a veterinary surgeon's professional judgement to be used. In addition, these new measures will be consolidated sensibly with previous guidance on the provision of information about fee estimates and prescriptions," according to Mr Ware.

"Implementation through the Guide allows the profession to maintain its self-regulation. This is preferable to the recommendations being implemented by an Order made under the Fair Trading Act 1973, which would subject veterinary surgeons to the enforcement machinery of the OFT.

Instead, enforcement will be through the RCVS's disciplinary process and the provisions of the Practice Standards Scheme," he adds.

These changes are due to take effect subject to the RCVS Council Meeting on 3 November, where exact wording will be agreed, and be incorporated into the online Guide at this point. They will be brought to the attention of members in the November issue of RCVS News, and a hard copy of the updated Guide will be mailed out in January 2006.

However, the RCVS is making a stand against recommendations which it feels are unworkable and unfair. The RCVS Council agreed that it would not be appropriate for those recommendations which it cannot or does not wish to enforce to be implemented through the Guide. Thus the recommendation for a zero prescription fee will not appear in the Guide; it will, however, be included in the Order.

Income ‘to fall’

Pet owners could end up feeling the pinch from the new regulations in the long run, according to Dr Freda Scott-Park, President of the British Veterinary Association.

"There is a downside to the recommendations," Dr Scott-Park told OUR DOGS. "If the costs of medicines is going fall, this naturally means that a veterinary surgeon's income will fall. Bearing in mind that vets receive no Government grant, no support in the fork of NHS-type funding. So they must make up for the inevitable shortfall in income somewhere else. You must also bear in mind that vets put a huge amount of care into animals – 24 hours a day, 7 days a week, 365 days a year. There are out of hours calls, appointments that allow the vet to see the animal on the day it requires an appointment. This all takes a considerable resource to fund.

"I think there is a serious issue here. Personally, I think we need to look at the consequences. If the cost of medicines comes down, that’s all to the good of the owner and patient. But we have also got to look at how a vet covers his or her overheads, which include veterinary equipment and supplies, heating, lighting, staff wages and so on. This Basically means that veterinary fees are going to rise. This will most likely mean higher consultation fees."

Dr Scott-Park pointed out that the Chairman of the Commission noted several times that members of the veterinary profession did not charge highly enough for their professional services.

"If you start to reference the cost of our consultation to the cost of calling out a washing machine repairman, then you see the vast disparity," added Dr Scott-Park. "A washing machine repairman will charge you £50 plus VAT before he’s even come through your door to look at the machine. Or think how much it costs to take your car into a garage, even before any work is carried out I think this puts into context what vets do, the value of their expertise. So the time has come to decide what we do charge for our professional services, and within the next 2 to 3 years, I can see a sharp rise in veterinary fees. People will see animals as a very expensive responsibility and will have to seriously think about that responsibility to their pets."

"It is clear that pet insurance is going to have to be more widely taken up by the pet owning public to cover any unexpected veterinary treatment, and this must all be seen in the context of needing the prepare for higher costs."

She concluded: "At the end of the day, it is not a terribly well paid profession – you just have to look at the salary scales - vets put an awful lot into the services they provide. Vets are really concerned about these new proposals - not just for their own livelihood but also for the welfare of the animals they treat every day."