Professional Autonomy does not mean Absolute Freedom! Understanding the current debate around autonomous practitioner status of the Neuro-musculoskeletal Professions in Animal Care.

Posted: 17.03.2024

RAMP advocates autonomous practitioners’ status. We believe this is essential to provide for fully regulated Neuromuscular skeletal (NMSK) professionals in any legislative change to the current Veterinary Surgeons Act 1966.

What is an autonomous practitioner?

RAMP see an autonomous practitioner as being accountable to a regulatory body who have a robust code of professional conduct and standards in place to ensure best practice. With this in mind, practitioners’ must work within their clearly defined scope of practice in collaboration with other veterinary and allied professionals to use their skillset for the benefit of their patient at all times. Practitioners that breech the boundaries of their scope or code of practice as a NMSK professional would be liable for investigation and disciplinary action imposed by an industry statutory regulatory body.

RAMP consider that such changes would benefit the public, their animals and vets giving clarity for both clarity both practitioners and the public around the legalities of treating animals.
Pending regulatory and statutory changes: RAMP’s position.

There is caution around creating additional autonomy for NMSK practitioners in animal care. In recent discussions with various stakeholders, it is easy to see that there are confusions and conflicted understandings. This includes query around what ‘autonomy’ would mean and the implications of autonomous practitioner status. Nonetheless, there is now a move towards regulatory and statutory change; RAMP believes such queries and confusions should be better understood before these occur.

Autonomous Practitioner status of animal NMSK allied professionals would benefit the public and their animals.
A competent register of NMSK professionals available to the public improves access to quality NMSK care from a highly skilled and appropriately qualified professional. Autonomy would remove the confusion caused as many assume the three NMSK professions (Chiropractic, Osteopathy and Physiotherapy) are regulated in the same way as in human care. Familiar and consistent standards would clarify who they could approach to ensure accountable registered professional help.
Currently owners often mistakenly consider less scrupulous practitioners who do not work with the vet as more skilled or better trained. If statutory and/or regulatory autonomy is granted, owners will be enabled in seeking seek the advice of skilled practitioners on a professional register in a manner that does not legally require a veterinary referral but are professionally obligated to work in collaboration with the vets.
RAMP registrants are currently professionally obligated to advise the owner to take their animal for a veterinary opinion should the issue fall out with their scope of practice. This would continue regardless of any statutory or regulatory change. However, having greater autonomy for RAMP registrants would potentially mean an owner can utilise the skills and experiences of an NMSK practitioner to triage and refer.

We expect that this would benefit the clarity, assistance, and availability of care available to owners and their animals. We also expect such a change would take pressure off vets for some NMSK issues yet speed up the professional referral of more critical issues, without heavy reliance on owner knowledge alone.

Autonomous Practitioner status would benefit Veterinary Surgeons.
RAMP has communicated with the Veterinary Profession over the past 15+ years, speaking to Professional Associations and attending BSAVA, BEVA and LVS conferences. As a Council we have learned that there is majority support for competent regulation of NMSK practitioners and in general agreement of the standards set by RAMP. There is an appreciation for RAMP doing the due diligence for practitioners’ qualifications and enthusiasm for a one stop solution to make a complaint or voice a concern regarding the practice of a registrant.
This impartial and independent form of regulation mean vets can be comfortable that animals assessed by RAMP registrants requiring veterinary care will be referred to them in a timely manner.
Due to the complexity of the NMSK industry vets are often unsure whom they should refer and what skills and qualifications the NMSK professional has. This often results in underutilisation of quality NMSK care and drives owners to the less skilled practitioners and sadly Google searches.
RAMP regulated practitioners are insured, and as autonomous professionals would continue to be fully responsible for the service they provide. Autonomy for regulated professionals removes any legal liabilities from vets for the care delivered by these regulated professionals, vets only need take responsibility for care they delegate to unregulated practitioners.
Veterinary surgeons are under increasing pressure from owners to refer to their preferred practitioners regardless of the practitioner’s skill level and regulatory status. RAMP believes that through its regulation it provides a clear and distinguishable differentiation between NMSK providers that vet - and insurance companies- can rely on.
Vets would gain additional collaborative support from full and honest skill sharing allowing both veterinary and NMSK practice to develop in parallel within a solid multidisciplinary team (MDT) model centred around the animal and owner. This would widen the scope of a modern veterinary healthcare system, where all professions could benefit from the skillset of others, enabling best holistic care to our patients.

A paper discussing autonomous practice in medical care states:…
‘The key to responsiveness to ideas for improvement is the need to encourage physicians to bring forward ideas and to eliminate fear of reprisal for identifying opportunities for change or for appropriate variation in clinical practice. To ensure health care is truly patient-centred, physicians should be supported to continue using collaborative approaches to leadership and decision making.’

Autonomous Practitioner status would benefit NMSK Professions.
There are five key aspects of autonomous practitioner status for regulated NMSK professionals.
1. With autonomy comes responsibility to reach and maintain excellent practice for the individual. Professional autonomy does not mean absolute freedom. Instead, the notion comes with responsibilities to serve the best interests of animals by providing high quality evidence-based care and referring on to another professional when they reach the parameters of their scope of practice.
Standards of care should be achieved by adhering to the Professional Standards laid down in the RAMP Foundation document. This document was informed by the standards published by the three statutory regulatory bodies in the human professions and discussions with DEFRA and the Royal College of Veterinary Surgeons (RCVS).
2. Building a career as part of the true MDT allows professional development utilising the full skill set of a NMSK professional. This provides best care for patients and also increased job satisfaction.

3. Did you know human practitioners gained autonomy in 1978?
RAMP believes that this example should be followed for increased harmony of working between practitioners. Autonomous status is essential to maintain the integrity and earn the professional respect for the three NMSK professions enjoyed in human practice.
Allocating RAMP level regulated practitioners’ autonomous status would inspire many more practitioners to educate themselves to the entry level requirements. This in turn would place them within a model of regulation where professional standards would need to be maintained.
4. Education providers would be encouraged to deliver good quality and verified programs to support practitioners reaching the transparent industry registration criteria.
5. Practice quality would improve as facilitating client access to highly qualified practitioners would support recruitment and retention of skilled and qualified professionals in the animal MSK industry.
Retention of good quality, highly trained individuals is essential if standards and care is to be developed and the number of professionals working at this level increased and available to the public.
Currently the lower number of RAMP level practitioners in the UK creates a vacuum and provides greater opportunity to those working at a far lower standard. Defining those that are registered by granting autonomy would encourage registration for those that are eligible.
Defining industry accepted clarification of pre-registration standards also encourages a spirit of optimisation and education, including further support and supervision, where required, to protect the public and securing the integrity of the professions.
Working together for common aims: Taking inequality off the professions to get the job done!

Current day pressures stress the all the MDT members and owners concerned with animals. The demand for quality care and quick cost-effective answers puts a burden on everyone’s wellbeing. The legal grey area around the treatment of animals compounds the tension, confusion and discourage open discussion around individual cases. RAMP believes the current legal position necessitates an unhealthy hierarchical obligation on both the vet and the NMSK practitioner that is poorly understood and often resented by the public.
Using the care on offer for the protection of animals, the public and all industries.

RAMP believes that its eligible practitioners are an under used asset due to inconsistency, confusions, and lack of autonomy across the industry. In many cases this means less appropriate care or guidance is given to animal owners and, highly educated professionals feel undervalued or not adequately supported so leave the industry and dilute the sector skillset.
RAMP argue autonomous practitioner status for regulated NMSK professionals would reverse this negative trend, also support and future proof the provision of a modern veterinary healthcare system; and ultimately improve animal welfare.
If you are interested to find out why the animal NMSK industry needs RAMP and why legislation needs to change, please follow our Facebook page, RAMP-Register of Animal Musculoskeletal Practitioners and website for the last blog. Good Intentions, Unintended Consequences The development of regulation for animal neuromusculoskeletal practitioners.

The RAMP Council
March 2024