Veterinary advice for practising vets

NHS Do’s & Don’ts:

For advice relating to good hygiene practises both personally and more generally in the practice.

In the current situation it is sensible to be diligent in adhering to good hygiene practises both personally and more generally in the practice. Simple measures include hand washing and making sanitizer available to all staff and clients. See basic NHS Do’s & Don’ts here.

If a member of staff does develop COVID-19, please refer to current NHS stay-at-home advice, found here. 

WHO infographics:

For useful infographics that can be placed around the practice to remind staff and clients how best to adhere to good hygiene are available here

PHE guidance on social distancing in the UK:

Managing social distancing between staff and also, between staff and clients, in line with Government advice found here is a challenge. To maintain social-distancing, consider the following:

• Ask all clients, to call the practice in advance before arranging a visit
• Maximise your communications about keeping clients up-to-date on your practice measures through direct contact by post or e-mailing and also, through social media channels. Place polite but clear notices at entrances to remind visitors of these measures
• Restrict entry to the practice where possible:
  • Consider a pick up box located outside the practice for pre-arranged, staggered medicine collections, prescriptions or other items
  • Allow entry only by means of a visitor ringing a doorbell
  • Where clients need to visit the practice, minimise queuing by agreeing pre-arranged appointments and pet collections
  • To minimise any congestion, designate separate entry /exit points where possible
  • At reception areas, consider providing protective screens
• If an examination of a pet is required, where possible carry this out independently of the owner with support from staff. Adhere to RCVS Guidance and depending on the circumstances, wear disposable gloves and apron/overalls.
• If a client is required to be present during a consultation:
  • Request only one client accompany the pet
  • Provide them with access to hand sanitizer and hand-washing facilities  
  • Aim to minimise the length of the consultation and the number of staff that need to be involved

In these challenging times, consider in particular the needs of vulnerable pet owners such as the elderly or those with compromised health conditions who are socially distancing for a long period to protect their health. Helpful support can include:

• Posting medicines
• Suggesting they wait outside in the car or carpark
• Visiting at a quiet time of the day
• Planning consultations with more time either side
• Having a telephone conversation with the owner whilst examining the pet
• Organising a home visit (see APHA Vet Gateway below for further advice) 

Travel to Work

Make employees aware of how best to manage their journey to work so as to maintain social distancing and minimise spread of the virus. Government advice for travelling in shared cars or on public transport is available here.

Similar guidance specific to Wales has been issued by Welsh Government on taking all reasonable measures to maintain physical distancing in the workplace.

APHA Vet Gateway:

Government advice for companion animal vets and their clients on management of pets in need of examination or treatment which are from a household with confirmed or suspected cases of COVID-19 is available on the APHA Vet Gateway, specifically Briefing Note 10/20. 

For the latest guidance and FAQs from the RCVS please visit the RCVS website here.

As part of the latest RCVS guidance, please see the RCVS flow chart which is intended to help veterinary practices decide whether or not to carry out a particular type of work. This Guidance is time limited therefore please check the RCVS website regularly for updates. The flow chart can be accessed here 

To support RCVS guidance, BSAVA has produced some tips that could include the following actions to be taken by practices:

• Reduce all unnecessary face-to-face consultations
• Use telephone or video calls to obtain a history and triage or consult remotely
• Obtain payment over the phone or by BACS but please be considerate of those for whom this is not possible
• Post medication where possible following Post Office guidance and, where applicable, following RCVS controlled drugs guidance

• Anyone who can work at home, should do so including administrative staff and vets and nurses carrying out remote calls or video consultations using remote access and diverted calls.
• Only pets who following remote assessment are deemed to require physical treatment should be directed to the practice premises where staffing levels should be kept to a minimum.
• If you do need to physically examine a pet, to manage social distancing:
  • Keep all external practice doors closed/locked at all times
  • Clients should make the practice aware when they have arrived
  • Pets should be collected from outside
  • If possible, clients should remain outside whilst the patient is examined away from the owner.
• See our section on ‘Good Hygiene and Social Distancing’ for further information. In particular, ensure all staff have access to readily available hand sanitizer and hand-washing facilities
• Use suitable protective clothing such as disposable gloves, apron or overalls. Detailed guidance on the use of PPE is available from the RCVS Knowledge COVID-19 resources hub here 
• Change into/out of uniforms onsite and wash uniforms onsite.
• After examination, treatment plans should be discussed and agreed over the phone
• Following examination, adhere to cleaning and disinfection practices of surfaces and equipment using virucidal products.
• If you need to refer a pet to a referral centre, discuss the Centre’s measures with them in advance of making arrangements for transfer by you or the owner

See our section 'BSAVA Resources’ which is intended to provide you with additional guidance including our Neutering and Vaccination Guidance and resources.

Managing the Practice Resources

To manage the reserves of your practice, consider the following:

• Preserve supplies of essential medicines including oxygen and analgesia. There should be no need to stockpile medicines
• Where possible, work with local practices to share resources and rotas
• If possible, split your team to minimize disruption due to cases of self-isolating across a single practice team
• Consider staggering breaks between teams in case one team needs to isolate

RCVS Advice to clients

RCVS have issued advice for clients that aims to manage client expectations of the services veterinary practices can offer during the current situation. It should help them understand how vets are currently required to prioritise public health and safety, whilst also working to uphold animal health and welfare in extremely challenging circumstances. You can point clients to this advice which is available here

BSAVA has produced a toolkit of resources to support small animal vets in practice. It is intended to complement BVA and RCVS Guidance.

For RCVS guidance, please see our section on ‘Practice Staff & RCVS Guidance’

For BVA guidance, please see our section on ‘UK Veterinary Resources and Information’

Remote consultation

Managing social distancing between staff and clients so as to comply with Government advice can present a challenge for vets in practice. To help maintain social-distancing and minimise the need for clients to visit the practice, it may be useful in the first instance to assess a case remotely so it can be decided if the pet needs to be seen for a face-to-face consultation or if it can be managed remotely. BSAVA’s Remote Consulting guide aims to support vets with their initial assessment and is available to download here

Obtaining owner consent remotely

Please see our downloadable easy reference guide written by Carol Gray for ‘Obtaining Owner Consent Remotely’ here.

Neutering

Please see our BSAVA Information Sheet on factors to consider before agreeing to neuter small animals during the Covid-19 pandemic. It covers surgical procedures and medical treatments that can achieve neutering in dogs, cats, rabbits and ferrets. The guidance should be read in conjunction with RCVS guidance and the accompanying flowcharts and documentation. It is effective from 14th April 2020 for the next 2 weeks and on a rolling 2 week basis thereafter. All the advice is intended as a guide to assist BSAVA members but it is not a replacement for professional judgement. The responsibility for clinical decisions resides solely with the attending veterinarian. Please access it here.

BSAVA has produced advice for clients as to whether or not their pet can be neutered during the COVID-19 crisis. It outlines what to expect when they contact their vet to discuss neutering for their pet. It explains that their vet is required to risk-assess each case and apply their professional and clinical judgement when deciding on the best course of action for a pet’s individual circumstances whilst keeping in mind government requirements relating to travel and social distancing. This advice on neutering which vets can share with their clients is available here.

Anaesthesia Resource

There will be a need for anaesthetics where a veterinary surgeon has risk assessed a case, applied their clinical and professional judgement and deemed anaesthesia is required. Please see our advice on administration of anaesthetics during the COVID-19 pandemic here. 

We also have a collection on Anaesthesia on the BSAVA Library, freely available until the end of June. Please access it here.

Triage tool for cats and dogs

Please find our new triage tool to help vets in practice identify and process emergency canine and feline cases during the challenging circumstances presented by the Covid-19 pandemic. The tool is available to all vets, free of charge. You can see it on our dedicated web-page here.

Microchipping

Please find information on ‘Microchipping’ under the ‘UK Veterinary Resources and Information’ section.

Vaccination information

This is a BSAVA Information Sheet on factors to consider before agreeing to vaccinate small animals during the Covid-19 pandemic. This guidance should be read in conjunction with RCVS guidance and the accompanying flowcharts and documentation. It is effective from 14th April 2020 for the next 2 weeks and on a rolling 2 week basis thereafter. All the advice is intended as a guide to assist BSAVA members but it is not a replacement for professional judgement. The responsibility for clinical decisions resides solely with the attending veterinarian. Please access it here.

BSAVA has produced advice for clients as to whether or not their pet can be vaccinated during the COVID-19 crisis. It outlines what to expect when they contact their vet to discuss vaccination for their pet. It explains that their vet is required to risk-assess each case and apply their professional and clinical judgement when deciding on the best course of action for a pet’s individual circumstances whilst keeping in mind government requirements relating to travel and social distancing. This advice on vaccination which vets can share with their clients is available here.

British Veterinary Association - 

Updated guidance issued by BVA is available here. It's effective from 14^th April and will be reviewed in light of any further government instructions or relevant information so please check the BVA website regularly for updates. The BVA Guidance is aimed at helping vets consider how to assess cases during the continued COVID-19 lockdown restrictions. Please note that it is intended as guidance only and veterinary professionals should continue to exercise their clinical and professional judgement. The species specific advice for small animal vets on pages 3-5 of the Guidance which includes the lists of examples, is not exhaustive and veterinary practices may vary in their approach dependent on individual and local circumstances. It is intended that the BVA Guidance is read in conjunction with RCVS Guidance and BSAVA species specific guidance and resources.

BVA have made the following advice for veterinary practises for dealing with behaviour cases.

You can find the links to all of the BVA webinars for COVID-19 and the veterinary profession here.

RCVS Knowledge - COVID-19 resources here 

SPVS - COVID-19 resources here.

NOAH - Information on supply of veterinary medicines can be found here.

VMD - News and guidance about the impact of COVID-19 on veterinary medicines related issues are available from VMD. Information covers the availability of authorised veterinary medicines, arrangements for inspections, and also, changes affecting veterinary practices and prescriptions. The latter covers the temporary relaxation of the enforcement of specific provisions of the Veterinary Medicines Regulations (VMR) 2013. All updates are available here. 

Testing pets for SARS-CoV-2 & International Reporting Obligations

The detection of infection with SARS-CoV-2 in animals meets the criteria for reporting emerging infections to the World Animal Health Organisation (OIE) (of which the UK is a member country). Whilst SARS-CoV-2 is currently not a notifiable disease in animals in the UK (or EU), vets in practice have a professional obligation to report any positive test results to the competent authority to support the UK’s international reporting obligations to the OIE.

Globally only a small number of cases of naturally acquired SARS-CoV-2 infections in animals have been reported. Human-to-human transmission is still considered the main route of disease spread. Testing for SARS-CoV-2 in pets should only be undertaken where it is in the interest of the health and welfare of the pet.

Based on existing scientific knowledge, the UK Government advises that private testing should only be considered in pets which meet all four criteria set out in the case definition and that oropharyngeal and rectal swabs are the only suitable specimen types. Testing undertaken at private laboratories should be based on the detection of SARS-CoV-2 viral RNA in animals via PCR (typically RT-qPCR) or an equivalent assay.

In the event of a positive test result, vets in practice are asked to make clients and diagnostic laboratories aware of certain actions required by Defra. All information should be handled with appropriate confidentiality.

Further information on the background to testing of pets and the detailed requirements vets in small animal practice should fulfil when undertaking testing or reporting results, are available in APHA Briefing Note 18/20 available here.

Please see additional Government guidance for vets in practice on management of pets in need of examination or treatment which are from a household with a confirmed or suspected case of COVID-19, in APHA Briefing Note 10/20 available on the APHA Vet Gateway

Please see RCVS advice on testing for SARS-CoV-2 in the RCVS’s FAQs (Question 22) on COVID-19 here

ABCD - A detailed veterinary resource that answers common questions on COVID-19 and cats can be found here.

The Links Group -The Links Group are there to help raise awareness of the link between the abuse of people and animals through support, training and inter-agency working. See their website here. 

VDS Advice on policy cover during the COVID-19 outbreak is available here. If you need bespoke advice please contact VDS on 01565 652737 or e-mail admin@thevds.co.uk

A number of free webinars have also been made available to provide support for all veterinary staff and students, including ‘Sunday Surgeries’ for vets, RVNs and the wider practice team; ‘Wednesday Wellness’ for veterinary students; and a webinar to support vets new to remote consulting.

SAVSNET

SAVSNET are aiming to help practitioners through data collected from contributing veterinary practices and veterinary diagnostic laboratories and to support this aim have released a specific report detailing the impact of COVID-19 social distancing measures on the following key areas of companion animal practice - consultation volumes, vaccination, telemedicine and vaccine preventable disease. The report can be accessed here. This is the first of regularly released reports and whilst it is primarily intended to be a source of evidence-based support for practitioners, it may assist policymakers and practice group leaders when making broader decisions too. As time goes on, SAVSNET intend to further develop these reports. SAVSNET works in partnership with BSAVA and BBSRC and if you would like to contribute data from your practice to SAVSNET, please visit their website to find out more here. 

Pet insurance and claims

Currently (08/04/20) The Association of British Insurers (ABI) advice for pet insurance policies during the COVID-19 outbreak is available here.

If a pet owner or practice client has a pet insurance policy underwritten by RSA including those by John Lewis, >Than, Tesco and Marks & Spencer, RSA advises that policy holders visit the retailer’s website for further information here.

Availability of Medical Gases

Currently (08/04/20) there is no indication that there is a shortage of available medical gases. In preparation for an escalation of COVID-19 cases, BOC has been building stocks of medical gases, where able, to ensure their supply chain is in the best possible position to respond to customer requirements. BOC has now implemented a ‘Full for Empty’ supply of all medical cylinder gases to ensure that supplies can be maintained and fairly distributed to all customers.

Customers with medical oxygen are being encouraged to manage their cylinders in an effective manner and ensure that empty cylinders are available promptly for collection and reprocessing by BOC. An increased frequency of deliveries and collections is available to assist with cylinder turnover. Customers are asked to be vigilant and ensure that medical gas cylinders are kept as secure as possible to deter potential misuse or theft. BSAVA understands that if a practice is closed for the foreseeable future, BOC will collect cylinders free of charge.  For further information individuals can call BOC’s Customer Information Centre on 0800 111 333. Further information is available here.

Potential use of Propofol by NHS

There have been anecdotal reports that veterinary practices might be approached by the NHS or DHSC to discuss requests for propofol intended for use in supporting safe mechanical ventilation when treating patients for COVID-19. BSAVA has liaised with VMD to ascertain the validity of these reports. It has been confirmed that DHSC has not initiated a call directly or indirectly to requisition veterinary medicines. There are ongoing cross-Government discussions between relevant Departments to assess the potential for VMPs to be used in an emergency for human use however, to date this work in incomplete.

Whilst no call has been made by DHSC (as of 09/04/20), if at any point a veterinary practice is approached with a request to release propofol to DHSC, please keep in mind some important information outlined below which has been produced by BSAVA and AVA President, Carl Bradbrook, working closely together. The information is intended to ensure no human lives are unintentionally put at risk. 

• There are different formulations of propofol some of which can be fatal if applied for human use. In particular, some preservatives such as benzyl alcohol must not be applied for use in humans.
• The non-preservative preparations of propofol might be suitable for humans however, it should be for DHSC staff to ascertain and confirm suitability.
• If a veterinary practice is approached, before releasing any propofol to DHSC, it is advisable to always provide the datasheet for DHSC to check it is suitable for human use, especially to confirm it is a preservative free formulation.
• Only transfer propofol after you have written confirmation from DHSC that it is suitable to do so and the formulation is appropriate. Ensure appropriate records are kept of any stock transferred to allow for tracing and eventual replacement.

It is good practice to apply the above principles to any veterinary drugs if you are requested to release them to NHS or DHSC.

Microchipping

CFSG has provided advice for animal related businesses (excluding veterinary practices) and breeders where it indicates that it may not be possible to vaccinate and microchip puppies or kittens in the current lockdown. Breeders and purchasers are advised to contact their veterinary practice to discuss individual and local circumstances relevant to their pet. Where there is a high risk of infection with severe disease such as Canine Parvovirus the practice may be able to provide suitable arrangements for vaccination. If vaccination is undertaken the pet should be microchipped at the same time if not already implanted. CFSG information can be found here. 

Mental Health and Wellbeing for Practice Staff

Webinar Vet Mental health webinars, including MMI webinars with RCVS, are freely available and can be accessed here.

FECAVA resources on mental health and wellbeing can be found here.

Vet Life Obtain individual advice and support by accessing Vet Life services here.

RCVS Mind Matters Initiative - here.