UPDATE FROM RAMP

Preparation for the relaxation of lockdown 

Dear all, 

As you are aware, the release of guidelines by the RCVS takes effect in England and Northern Ireland as of the 12th April, This enables practitioners across these counties to join our colleages in Wales and Scotland in returning to full clinical practice rather than essential/urgent services. 

RCVS will remove the flow charts previously used to support decision making and practitioners are asked to provide services in accordance with their professional judgment whilst remembering to continue undertaking the ongoing required biosecurity and social distancing measures as well as additional relevant government guidelines and restrictions. 

This has been a long road, and whilst we are not fully out of the end yet, many of our animal patients need MSK attention. RAMP holds animal welfare as a priority and while we have previously advocated treatment for urgent cases only inline with government and RCVS guidlines, we are aware that many regular patients are deteriorating without on-going treatment. We welcome the ability for our practitioners to offer care as appropriate to the wider animal population once again. However, the threat of Covid remains and social distancing is still in place which provides us with our biggest logistical challenge therefore we highlight that the professional judgement of the practitioner should always lead the decision as to whether it is safe to attend and treat an animal and remain conscious not only of their own safety but that of their owners and animals. 

Beyond the change in scope of practice, many of the previous guidelines remain regarding biosecurity, social distancing and safety measures. 

To remind you, here are some points that should be taken into account: 

  1. Animals with demonstrable pain and welfare issues should be seen, these may include all pathologies. 

  1. A pre-visit risk assessment and telephone call is essential. Gain as much information prior to the visit as possible to minimise contact time. If appropriate, would the use of an oral sedative, supplied by the clients’ vet to the client, mitigate risk? Do you have access to a responsible ‘safe’ handler that can attend with you? 

  1. No appointments should be made with anyone who has Covid symptoms or who is in close contact with anyone with Covid symptoms. There must be a 10-day quarantine period for them, prior to seeing them. Consider the suitability of wearing a mask to reduce the risk of the practitioner spreading Covid between yards/clients. Consider asking owners/handlers to wear masks to reduce the risk of transmission to the practitioner. 

  1. If you have symptoms do not treat, get tested, and await a clear result, prior to seeing any clients. 

  1. Animals with owners in the vulnerable categories should not be treated in the normal way. Try to see if any other approach other than face to face can be used or if there are mediated ways of treating the animal in person. 

  1. Small animals should be seen in a clinic setting, (physio or vet) rather than home visits if possible, as cleanliness, disinfection and biosecurity are easier to control. If home visits are necessary, ensure that no other pets/family etc are present. In a clinic setting explore the possibility of treatment without owner present. Risk assess home visits very carefully. 

  1. Yard visits- Risk assess individual setups. As a professional you will be aware of the situations, and risks, at each of your regular yards. Some may be relatively ‘safe’, others less so. The decision to attend a client should be dictated by the risk assessment. 

  1. Home/yard visits, ask for gates to be opened and closed for you to minimise touching surfaces. No loose dogs/cats around that could transmit virus via petting, ensure animal is ready and waiting for you (ie no putting on headcollars, leads etc and unnecessary handling of owners equipment), carry your own soap and towels to wash between visits and ask for a fresh bucket of warm water or easy access to sink to wash. Accept no refreshments. 

  1. Other considerations, can the animal be left tied up with the owner at an appropriate distance? If not, are there any other strategies to improve safety and appropriately handle and restrain the animal. Is this a safe approach for you, the client and the animal? 

  1. Is this animal safe to treat with these restrictions in place? 

  1. All visits should be risk assessed and the results documented. Including those where treatment is refused and the reasons why, with documented details of the explanation to the client. 

  1. Payment- attempt to remove the need to handle payments. Request payment by BACS/credit card/paypal. 

  1. This is not a return to normal, please follow all PPE, and government guidelines and advice.. 

This is not an exhaustive list of all the possible considerations and scenarios but some guidance. Your professional judgement and expert opinion should be used at all stages to ensure yours and the client’s safety while also minimising the risks of spreading Covid 19. 

The professional judgement of the practitioner, based on a thorough risk assessment, should always lead the decision as to whether it is safe to attend and treat an animal. 

Your professional Associations will offer instruction of their plans for relaxation of lockdown restrictions, please pay heed to their guidance. 

The RAMP team

Update from RAMP

Update from RAMP

Release date 5/4/21

RAMP have been made aware of a couple of issues around title use so, as a reminder, RAMP Registrants who are not regulated with HCPC,GCC or GOSC may use the term chiropractor, osteopath or physiotherapist ONLY if it is prefixed with an animal term.eg equine, canine or animal etc. It must be made clear on any website, leaflet or other marketing that you do not use these techniques on humans. Failure to do so could result in prosecution as this is a criminal offence.
Please ensure that you comply with the law as it applies to you.
Thank you

To clarify the law as it stands here is a copy of the Barristers advice that RAMP commissioned. It makes it clear that the current laws around protected titles only cover human practice BUT that if they are used in the animal field it must be made clear that the practitioner does not treat humans unless also qualified to do so.

1. Introduction: The Issues. I have been asked to advise upon the scope of the protection of title for Chiropractors, Osteopaths and Physiotherapist (“the professions”). Specifically, I have been asked whether the protection of title which exists for these professions applies when the practice of the individual chiropractor, physiotherapist or osteopaths relates to and is carried out upon, an animal and not a human patient.

2. This Advice has been commissioned by the Register of Animal Musculoskeletal
Practitioners (“RAMP”), which is concerned to understand the legal parameters in which its members operate. RAMP has established a voluntary Register of professionals who are trained in chiropractic, osteopathic and physiotherapy techniques and treatments for animals. They are regarded by RAMP as one occupation, i.e., animal musculoskeletal practitioners.

3. Summary of Advice.
a. The Acts and the Order governing the practice of osteopaths, chiropractors and
physiotherapists are concerned exclusively with the regulation of the treatment of human patients (paragraphs 9 – 21 below); Legal Advice, 28 January 2020 2
b. As a result, the titles concerned are not protected titles, outside of the context of the treatment of human patients. There is no statutory or other legally binding regulatory framework governing their use outside of that context;
c. In my view, provided that any description makes it plain that the practitioner does not purport to be qualified to, or to treat, human patients, and is not on the Register of those professionals who would do so, an exclusively ‘animal’ practitioner may use the title ‘physiotherapist’, ‘osteopath’ and ‘chiropractor’ provided that these terms are always accompanied by a clear and proper explanation of their animal practice so as to make these vital distinctions.
d. The question of what is a sufficiently clear explanation is a question of fact. It would be for the individual practitioner to satisfy himself or herself that the rules on the protection of title had not been infringed. Clearly, a protocol which had been agreed with the three regulatory bodies concerned with human treatment would be the best way forward. I would suggest that merely using the title ‘animal physiotherapist’, etc, (or ‘equine chiropractor’, to take a similar example) may not be enough to achieve complete clarity – it ought to be accompanied by an
explanation, on websites and other literature, of the distinction and the fact that the
practitioner does not purport to be qualified to, nor offer treatment to human patients.

The RAMP team

BEVA Guidelines

Keeping you safe

Hello everyone having reviewed the latest government, RCVS and BEVA guidelines for England, we remind our members to ensure they make a professional judgement regarding the treatment of animals and to take suitable precautions to ensure safety of yourself, the animal and the owner.
 
Remember to use appropriate PPE and to check whether the owner is currently well and whether they have been in contact with anyone with covid symptoms or who has tested positive for Covid in the last 10 days. For each patient, carry out a risk assessment. Keep a close eye on RCVS and Government guidelines.
 
The current Government advice for England includes the following:
* You may only leave your home for work if you cannot reasonably work from home.
* Where people cannot work from home …. they should continue to travel to their workplace.
* This is essential to keeping the country operating and supporting sectors and employers.
* Where it is necessary for you to work in other people’s homes – for example, for nannies, cleaners or tradespeople – you can do so.
 
* You may leave home for Animal welfare reasons such as to attend veterinary services for advice or treatment.
 
Businesses and venues that may remain open include:
* medical and dental services
* vets and retailers of products and food for the upkeep and welfare of animals

Important Update from the RCVS and DEFRA

regarding consent for Veterinary Osteopaths, Chiropractors and Physiotherapists to Treat Animals

Important information for Owners, vets and practitioners, there has been a clarification regarding consent from vets for #animalosteopath, #animalchiropractor and #aniamlphysiotherapist practitioners to treat animals.The update from #RCVS can be found on their website at: https://www.rcvs.org.uk

The following update has come from RAMP (#RAMP #RAMPregister)

www.rampregister.org
RCVS Guidance clarification for MSK Practitioners. The following Guidance has been passed by the RCVS Standards Committee and will be circulated among the veterinary profession:

a) Musculoskeletal therapists are part of the vet-led team. Animals cared for or treated by musculoskeletal therapists must be registered with a veterinary surgeon. Musculoskeletal therapists carry out a range of manipulative therapies, including physiotherapy, osteopathy and chiropractic therapy.

b) As per the Veterinary Surgery (Exemptions) Order 2015, remedial treatment by ‘physiotherapy’ requires delegation by a veterinary surgeon who has first examined the animal. ‘Physiotherapy’ is interpreted as including all kinds of manipulative therapy. It therefore includes osteopathy and chiropractic but would not, for example, include acupuncture or aromatherapy. It is up to the professional judgment of the veterinary surgeon to determine whether and when a clinical examination should be repeated before musculoskeletal treatment is continued.

c) The delegating veterinary surgeon should ensure, before delegation, that they are confident that the musculoskeletal therapist is appropriately qualified and competent; indicators can include membership of a voluntary register with associated standards of education and conduct, supported by a disciplinary process. As the RCVS does not regulate musculoskeletal therapists it cannot recommend specific voluntary registers.

d) Musculoskeletal maintenance care for a healthy animal, for instance massage, does not require delegation by a veterinary surgeon. However, the animal must still be registered with a veterinary surgeon. Maintenance should cease and the owner of the animal should be asked to take their animal to a veterinary surgeon for clinical examination at the first sign that there may be any underlying injury, disease or pathology. Alternatively, the musculoskeletal therapist may ask the client for formal consent to disclose any concerns to the veterinary surgeon that has their animal under their care.

This has come about as a result of RAMP Council consultation with DEFRA and the RCVS around clarification for veterinary consent for Competition and Maintenance Care.

To reiterate, the only difference to current practice is in point d). An animal declared healthy by the owner, in cases where care is given to maintain good health and optimise competition performance, can be seen without specific Veterinary referral with the caveats stated. This covers the areas of Maintenance care and Competition care ONLY.

This clarification will ease the current legal grey area and hope it will improve communication between MSK Practitioners and the Veterinary Profession. ANY pathology must be reported back to the animals registered vet immediately.

Guidance for Animal Practitioners

With COVID on the rise again, please use common sense and follow RAMP and RVCS guidelines. We all know to ask pertinent COVID pre-screening questions in advance of a visit and to touch gates, head collars etc. as little as possible. PPE wearing should be relevant to each case, based on your ability to keep a 2m distance from any person on the yard on in a garden – during the entire session. Where possible, treat outside. If you are inside treating an animal, you must be sure to follow PPE and hygiene guidelines to the dot.

Take your own cleaning and sanitising products to your visits. Make sure your owners know that you have clean sanitized hands and arms before touching their animal (after you get out of the car). Don’t shake hands, as before. Take your own food and drink with you. And where possible, ensure that you have a change of clothes between visits, if you are not wearing protective disposable items that can be disposed of, in between patients. This is because COVID can last on material for up to 3 hours.

More recently it has been announced that professionals in close proximity to people outside their household must wear both mask and visor – even if teaching (as opposed to treating). So, if you cannot keep a 2 meter distance from your owners, you need to keep this in mind.