18 Jul 2025
BEVA president Bruce Bladon said his organisation was “deeply concerned about misrepresentation” of the cascade after analysis suggested it could be barrier to care.
Allister Webb
Job Title
BEVA president Bruce Bladon.
A senior vet has warned patients are being “under-served” because of how the rules that govern veterinary drug prescriptions have been portrayed.
BEVA president Bruce Bladon said his organisation was “deeply concerned about misrepresentation” of the cascade after recent analysis suggested it could be a significant barrier to care.
The VMD has already insisted it has no plans to change the current rules, while the BVA urged caution over broader use of alternative human medicines.
But Dr Bladon argued that, instead of facilitating clinical freedom, many professionals are “intimidated” by a framework they regard as a restriction on their practice.
Dr Bladon said: “This study exposes how misrepresentation of the cascade has left practitioners confused and, therefore, patients under-served.”
The comments followed a study published by VetSurgeon.org which estimated that thousands of animal owners a week may be unable to afford licensed drugs that vets are required to prescribe under the cascade.
Its survey found 89% of respondents reported seeing cases of clients being unable to pay for such products once a month or more, with nearly 26% saying they witnessed incidents of that kind at least once a week.
The present system has also been called into question as part of the ongoing Competition and Markets Authority’s (CMA) investigation of companion animal services, although most veterinary sector groups continue to support it.
But BEVA’s unease has been known for some time after it called for restrictions on the consideration of financial circumstances to be lifted forthwith in a submission to the CMA last year.
Although the latest comments stop short of advocating direct changes, Dr Bladon pointed out there was no reference to cost within the Veterinary Medicines Regulations, while associated guidance made clear that financial considerations should not be the sole driver of treatment decisions.
Dr Bladon said: “Where financial barriers would deny access to treatment, this may represent a distinct clinical consideration within appropriate cascade decision making. That is fundamentally different from selecting cheaper alternatives for convenience.
“When a clinician determines that cost creates a genuine barrier to care, using the cascade appropriately is not a regulatory violation. It remains a clinical decision protected by legislation.
“The decision belongs to the treating veterinarian, and external pressure should not compromise that professional autonomy.”
BVA president Elizabeth Mullineaux said her organisation recognised the challenges faced by some pet owners due to financial factors, but maintained that cases must be considered individually because of potential risks associated with animal welfare and antimicrobial resistance.
She said: “Human equivalents are not necessarily chemically identical to veterinary medicines and may be metabolised by animals differently, whereas veterinary licensed products have been fully tested for safety, efficacy and bioavailability.
“Vets already use the cascade as a risk-based decision tree as part of a contextualised care setting, taking into account the individual circumstances of each patient and tailoring appropriate and proportionate care to the needs of both the animal and the client, including an understanding of the pet owner’s finances.”
