19 Feb 2024
“The BVA remains concerned that, while vets are learning to work with the new guidance, its complexities mean that many in practice are still unclear about how it applies across all clinical scenarios.”
Allister Webb
Job Title
Prescription-only medicines should no longer be supplied on a dosage per kilogram basis, according to new joint guidance from the RCVS and VMD.
The two bodies have joined forces to address what they said are the most common issues arising from the college’s new “under care” guidance on POM-Vs, which came into force last month. But concerns persist about the potential for confusion arising from the guidance in practice, amid calls for greater clarity on how the impact of the updated rules is to be assessed.
The new document, published on 12 February, considers eight scenarios including the compilation of clinical notes for ongoing treatment, supply issues and questions around the use of controlled drugs.
However, a key shift in the two bodies’ thinking appears to be relate to what clinicians should do if an animal either gains or loses weight following a POM-V diagnosis.
The paper said vets should record actions to be taken if the animal’s weight changes in clinical notes, including pack sizes and the need for a new clinical assessment if needed.
But it continued: “The recent guidance changes have prompted the RCVS and VMD to review certain areas with a renewed focus.
“Following this review, our advice is that noting prescriptions as mg/kg is not recommended due to possible errors being made when the dose is calculated.
“However, where the generic active ingredient is prescribed in mg/kg, you will need to authorise this prior to the product being dispensed.”
The document does reiterate the major change in under care guidance introduced last year by stating that the issue of whether to conduct a physical examination before making a prescription decision is a matter of individual clinical judgement.
However, it warned that such an examination “must” be carried out as part of a clinical assessment for the prescription of controlled drugs “unless there are exceptional circumstances.”
The paper also advised that an alternative authorised product can be named in clinical notes to be used in the event of manufacturing problems hampering the supply of a prescribed product, but a list of alternatives would not be considered “generally acceptable”.
It further cautioned that a new clinical assessment would be required before an alternative product was prescribed if no alternative had been suggested at the time of the original prescription.
However, a manufacturer-based supply problem would be considered an exceptional circumstance that would negate the requirement for a physical examination to enable the prescription of antiparasitic, antibiotic, antifungal or antiviral products.
Responding to the document’s publication, BVA senior vice-president Malcolm Morley said: “It’s good to see the RCVS and VMD working together to bring much needed clarity to aspects of the under care guidance which wasn’t entirely aligned with the Veterinary Medicines Regulations.
“However, BVA remains concerned that, while vets are learning to work with the new guidance, its complexities mean that many in practice are still unclear about how it applies across all clinical scenarios.
“Post-implementation review is critical to ensuring the guidance delivers against its aims, as well as highlighting any unforeseen consequences, and we look forward to more detail on this from the RCVS.”
The college has previously committed itself to holding a review of the new guidance 12 months on from its implementation, despite initially being advised that such a process should only be undertaken after two years.
