On 31st January 2013 the British Veterinary Association (BVA) released a statement calling on the Veterinary Medicines Directorate (VMD) to restrict all anthelmintics to become Prescription Only Medicines (POM-V). Is this a justified statement, or a reflection of one aspect of the animal industry being out of touch with current working practices in another?
There is a serious rising problem in anthelmintics resistance in grazing animals across Europe as a whole, including those countries where these medications are currently only available through vet-only channels.
When anthelmintics are prescribed (either POMV, POM-VPS, NFA-VPS) the prescriber needs to demonstrate that the animal(s) is in their care, that the owner is competent in the administration of the medications, and that there is a requirement based on clinical diagnosis that the medication is required. The prescriber doesn't need to be present when the medication is dispensed, as long as the prescriber is happy that the person dispensing the medication is competent, and that they have checked the medication has been labelled appropriately before dispensing. In veterinary practice it is very unlikely that the veterinary surgeon will be dispensing the anthelmintics directly to the farmer, it does tend to be veterinary nurses, receptionists or in some cases SQPs (suitably qualified person) employed by the practice. I am personally in a fairly unique position; I have worked in large animal practice, I am a veterinary nurse and a SQP, and I regularly ‘see practice’ in an agricultural retailer. I am always envious of the amount of time that the SQPs in the agricultural retailers have to talk to farmers. Not just about parasite control, but advice on how to correctly weigh their animals, which is the best product for their animals and on discussing new ideas on general husbandry and health care. SQPs prove to be an important contact point for advice for farmers.
Veterinary nurses and receptionists (those that tend to dispense) rarely have formal qualifications in large animal parasitology, the SQP qualification is taught at Level 4 (first year degree level) and requires higher levels of understanding of not just parasitology, but also requirements for prescribing and dispensing. SQPs also have to undertake compulsory quality assured CPD in their specific area, including CPD on good practice in parasite control, in each CPD period. The CPD course is assessed by AMTRA prior to delivery and awarded CPD points dependent on quality, depth of coverage of the syllabus and the length of the course; similar to the Continuing Education scheme for veterinary technicians in the USA. This goes much farther than the majority of veterinary CPD courses in the UK, and I personally feel that veterinary nurse and surgeon CPD should aspire to this level. Multi-choice questions are also used to determine that CPD has been understood and learned. The anthelmintics issues does raise the question that should all persons (including veterinary surgeons) that are prescribing and dispensing these medications undertake compulsory CPD on resistance, responsible use of anthelmintics and new protocols surrounding the issue?
There is also a dramatic welfare issue in restricting the prescribing of all anthelmintics to veterinary surgeons. There has been little evidence to show resistance of anthelmintics in small animals, and with the zoonotic implications of some parasites, and cost implications this will impact on welfare.
It should also be noted that independent bodies such as Sustainable Control of Parasites of Sheep (SCOPS) and Control of Worms Sustainable (COWS) work with SQPs to ensure that monitoring tools such as faecal egg counts (FEC) are utilised in order to determine whether parasite control is required. Resistance to anthelmintics is a very large issue, and can only be combated with combined forces from those prescribing and dispensing the medications (veterinary professionals/SQPs), and those administrating the medicines (farmers/animal carers).