Report on Consultation

Consultation Period: January 24, 2022 until February 24, 2022

Submissions: 99 Submissions

What is the Issue?

The College established a Professional Practice Standard on the veterinarian-client-patient relationship (VCPR) in 2016 and no substantial changes had been made since its publication date.

In Spring 2021, College staff conducted a targeted review of select policies that had not appeared before Council in several years. The review of the Professional Practice Standard: VCPR flagged key areas that required potential revisions to enhance clarity in several areas including the discontinuation of a VCPR and the recognition of unique scope of services.

In September 2021, a proposed draft amended Professional Practice Standard: VCPR was presented to Council. In-depth discussion continued to take place and additional points of consideration were raised including clarifying the required steps when establishing a VCPR and clarifying that a VCPR is required for prescribing, dispensing, and administering drugs. 

In December 2021, the Professional Practice Standard: VCPR was returned to Council with additional revisions for consideration. Based on its review, Council determined that the revised draft standard should be circulated for public consultation. Public consultation occurred from January 24, 2022 until February 24, 2022.

Why is it Important? 

The VCPR is the foundation upon which clinical veterinary medicine is based. VCPRs are unique in that no two relationships are the same. Each VCPR has its own circumstances and parameters that can be as wide-ranging as the animals they serve. Given this, the College strives to provide clear expectations and guidance that assist veterinarians and help empower safe and efficient practice.

Public interest is grounded in the provision of safe, competent, informed, and accessible veterinary care. The VCPR is fundamental to this provision. VCPRs are at their strongest when both veterinarians and their clients communicate and work together in the provision of veterinary services. This is especially true when VCPRs are used to facilitate care in rural, remote, and underserviced areas or in other situations where veterinary care may not otherwise be accessible. 

Consultation Process

The draft Policy Statement was sent for public consultation for a 31-day period during which members of the College and members of the public were asked to provide their feedback. 

What We Heard 

1. Confusion about the discontinuation of a VCPR

• How to end the VCPR in a fair and equitable way is not clear 

2. Confusion about the establishment of a VCPR

• Need know more “how” we establish VCPR. Does that mean the animal needs to be examined? Or do we need to have client sign the paper? Do we need to state the scope of service?

3. Concerns with After-Hours Care

• Concerned with emergency services being a requirement of the VCPR

Additional Themes

• Concerns with the draft Examples 
• Comments related to ongoing national conversations

Sample Comments

The following quotes, summarized from comments received, reflect suggestions received through the College consultation: 

• No definition is given for what appropriate scope of services entails in order to satisfy the CVO requirement.  Discontinuing the VCPR is not clear. If a client has their records sent elsewhere without contacting us, is that a discontinuation of the VCPR? I think that it should be, and I don't think we should have to send registered letters advising.
• I was wondering about addressing that a VCPR is often established with a veterinary practice, not necessarily with each individual veterinarian who works in that clinic (i.e. I am a locum and I do not take all the steps to establish a VCPR with each client I am seeing as long as they are a current client/patient of the clinic).
• I disagree with having VPCR's for one specific condition.  In the example listed, what if the ear infection came back 2 months later?  Did the VPCR discontinue once the ear was better and meds discontinued?  It seems like a waste of time for the veterinarian to explain it to clients and even then, clients won't understand anyways.  I believe that its either an all or nothing approach - you establish a VPCR with an owner and agree to provide full medical care to their animal.
• When I read the draft there was actually no mention of HOW a VCPR can be terminated, eg. can it be done via email/ phone call/written letter nor was there a discussion of the VCPR considered terminated at the death of the patient or if it can be considered in "inactive"  (not seen for more than certain number of years) clients.
• Overall the proposal appears clear on the expectations, however I am still left somewhat confused as to the practical application of establishing a VCPR.  The legislation indicates it can only be established by a veterinarian, however most clients come to the practice through a conversation with a receptionist and may not speak to the veterinarian until after their animal has been examined and recommendations made.  Is this sufficient?
• I like the clarity of group vs herd, and the definitions.  It does seem more relevant to today's version of veterinary medicine.
• I suggest that the after hours care statement specifically include referral to an accredited after hours or 24 hour emergency hospital within a reasonable distance.
• Veterinarians will understand what this information means.  The public does NOT understand any of this information and Veterinarians are struggling to communicate this information to their clients in a clear and non inflammatory way.  I believe it is the College's mandate to help all of us on this front.
• Also-the natural discontinuation of a VCPR works fine if a patient dies, however, I do truly believe that part of setting the scope of services - is a defined timeline for last patient examination and/or client interaction as it relates to when the VCPR naturally expires.  Clarity around that would actually be the most helpful.  OR at least communicating that Veterinarians CAN define this at the beginning of the VCPR if that is actually true.

How We Responded 

College staff made several revisions to the draft amended standards based on the consultation feedback. 

Council Direction and Decision

In March 2022, consultation feedback was presented to Council for its review and consideration. This feedback was accompanied by additional information that the College had received from relevant working groups, including the College’s Community Reference Panels and the Canadian Council of Veterinary Regulators Working Group on Access to Care. Given the proximity of the closure of the consultation to the meeting date, College staff did not present additional amendments to the draft standard. Instead, Council’s advice and direction was sought on next steps related to this work given the plethora of potential areas of consideration.

Following discussion, Council directed that the draft standard be returned to College staff for further work and consideration. 

Based on the information received from Council’s feedback College staff prepared an updated draft Professional Practice Standard: Establishing, Maintaining and Discontinuing a Veterinarian-Client-Patient Relationship (VCPR) for Council’s consideration and discussion in September 2022. At that time, Council directed that the updated draft Professional Practice Standard: Establishing, Maintaining, and Discontinuing a VCPR be published as amended, and the document was published in December 2022.

This consultation is now closed.