There is good reason why many medicines are prescription only (POM-V); in the case of antibiotics this is to ensure they are not misused resulting in the rapid development of antimicrobial resistance (AMR). The increasing awareness of AMR in recent years and high-profile reports such as the O'Neill Report (2016) have increased focus on veterinary prescribing, dispensing and administration of antibiotics. The RCVS Code of Professional Conduct for Veterinary Surgeons is very clear: ‘POM-V medicines must be prescribed by a veterinary surgeon, who must first carry out a clinical assessment of the animal under his or her care’. The phrase ‘under his care’ is not defined in the Medicine Regulations, but the RCVS has interpreted it to mean: ‘The veterinary surgeon must have been given the responsibility for the health of the animal or herd by the owner or the owner's agent’, ‘that responsibility must be real and not nominal’, ‘the animal or herd must have been seen immediately before prescription or recently enough or often enough for the veterinary surgeon to have personal knowledge of the condition of the animal or current health status of the herd or flock to make a diagnosis and prescribe’. It therefore follows that any veterinary surgeon can only prescribe to animals he or she has recently seen or that are on a farm they regularly visit.
The UK livestock sector saw a 45% decrease in sales of antibiotics between 2015 and 2019 and sales of highest priority critically important antibiotics (HP-CIAs) in food-producing animals fell by 21% between 2018 and 2019 (VARSS). The UK is now among the lowest users (mg/PCU) of antimicrobials in food-producing animals in Europe. This is something that we as a profession and our farming clients should be very proud of.
Nevertheless, while the answer to the title question above is that we are all responsible both individually and collectively as a profession, it is clear that not everyone follows the rules! We have laws and rules in a democratic society largely for the good of that society, with most individuals doing what is expected of them. A minority inevitably break the rules and others are given the responsibility of policing them. In the case of rules and regulations around the prescription and supply of POM-V medicines the enforcement of the law and professional standards rests largely with Trading Standards, the Veterinary Medicine Directorate (VMD) and the RCVS. It is clear from allegations recently reported in The Veterinary Record (2021; 188:166–167; 2021; 188:203, 204–205 and others), that a small minority in the profession may be undermining everything we have worked for regarding responsible medicine use, as well as risking the fundamental reputation of our profession.
I have heard it said many times that the authorities should stop a colleague, or practice, acting irresponsibly or illegally in their supply of medicines, or that they would act if someone gave them the evidence they need. While I make no judgement about recent allegations in the press it is clear now that some are willing to seek that evidence. Nevertheless, it should not need covert filming of veterinary practices, or the action of regulatory authorities to stop such unprofessional or illegal behaviour. We are a self-regulating profession. To truly self-regulate, if you, your business, or a colleague are suppling medicines irresponsibly now is the time to stop. The whole profession needs to work together to stop the few that risk our good name, every corporate or independent practice, and every veterinary surgeon needs to carefully examine their actions, and that of those around them, and act to ensure not just that they are working within the law, but that they are always following best practice.